Prof. dr. Sandra Nuyts Radiotherapy-Oncology

Radio(chemo)therapy for head and neck cancer

HNSCC: indications and modalities

March 2018

DISCLOSURE OF INTEREST

Nothing to declare

> Half

million new

cases

HNC/year

in world

50-60%

cured

not

cured

localfailure

Less side effects

More organ and function

preservation

distant

failure

More effective local and

systemic treatment

More effective systemic

treatment

Therapy of Head and Neck Cancer

Multidisciplinary!

Head and neck surgeon Radiation-oncologist

Maxillofacial surgeon Medical oncologist

Reconstructive surgeon Radiologist/ nuclear medicine

Dietician Pathologist

Speak and language therapist Tabacologist

Maxillofacial prosthodontists Socialnurses

Nurses

Dentist …

Current standard treatment for early HNC:

radiotherapy or surgery

– Surgery (organ sparing)

– Radiotherapy alone

• Often altered fractionation schedules

Current standard treatment for locally advanced

HNC: chemoradiotherapy or surgery

– Inoperabele locally advanced HNC: CRT

– Operabele locally advanced HNC

• CRT: Organ and function preservation

• Surgery + postoperative (C)RT

CANCER TREATMENT

radiotherapysurgerychemotherapy

hormonal therapy

immunotherapy

Atomic level

“Ionizing

atoms”

Photon

Ion

Free electrons

“Damaging

molecular

structure

of DNA”

Molecular level

“Impacting

intra-cellular

mechanism”

Cellular level

linear

accelerator

“Impacting

processes

in the human

body”

Probability of

Tumor Control

Dose (Gy)

1.0

0

Therapeutic

Effect (A)

Probability of

Normal Tissue

Damage

Increasing the therapeutic ratio in radiotherapy

Advances in radiotherapy for HNC

• 1. Lessons from randomized trials

• 2. IMRT: beyond parotid sparing?

• 3. New approachesOptimise

radiotherapy

Fractionation

schedulesTumorbiology

Technologicalimprovement

Concomitant

Chemo/biotherapy

Radiotherapy for HNC

• Primary setting

– Chemoradiotherapy

– Bioradiotherapy

– Altered fractionation

• Postoperative setting

– Chemoradiotherapy

Ionising radiation

Current standard treatment for locally advanced

HNSCC: chemoradiotherapy

– Inoperable locally advanced HNSCC

– Operable locally advanced HNSCC

• Organ and function preservation

Optimise

radiotherapy

Fractionation

schedulesTumorbiology

Technological

improvementConcomitant

Chemo/biotherapy

1.Primary

setting