RESUMEN

INTRODUCTION: For the treatment of head and neck squamous cell carcinoma (HNSCC), there are currently no official standard of care guidelines in German-speaking countries, with the exception of oral cavity cancer. In order to learn about the applied treatment modalities in the clinical routine, we conducted a web-based survey to evaluate the local standards of palliative and curative treatment of HNSCC. This article focuses on the curative treatment options and organ preservation strategies. MATERIALS AND METHODS: The survey consisted of a web-based questionnaire that was performed between November 2013 and July 2014. The questionnaire included ten multiple-choice questions and four open questions in the section about curative treatment. RESULTS: Altogether, 62 of the 204 addressed centers participated in the survey. For primary chemoradiation (CRT), most centers used a platinum-based chemotherapy (52/54, 96.3 %). Induction chemotherapy (ICT) was offered in 37 of the 62 centers (60 %). In oral cavity cancer, CRT and ICT were used in 37.5 and 4.3 % of the cases, respectively. In oropharyngeal cancer, CRT and ICT were applied in 44.5 and 10.3 % of cases, respectively. For hypopharyngeal cancer, 44.8 % of the patients received CRT and 11.8 % received ICT, while for laryngeal cancer 35.9 % received CRT and 9.4 % underwent ICT. CONCLUSION: Our data showed that a variety of treatments are used for HNSCC within German-speaking countries. Many centers offer ICT. The majority of the hospitals uses platinum-based therapy as a conservative first-line option in their organ preservation protocols.

Asunto(s)

Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/terapia , Quimioradioterapia/estadística & datos numéricos , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/terapia , Quimioterapia de Inducción/estadística & datos numéricos , Tratamientos Conservadores del Órgano/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Anciano , Antineoplásicos/toxicidad , Austria/epidemiología , Carcinoma de Células Escamosas/diagnóstico , Alemania/epidemiología , Neoplasias de Cabeza y Cuello/diagnóstico , Encuestas de Atención de la Salud , Humanos , Persona de Mediana Edad , Prevalencia , Carcinoma de Células Escamosas de Cabeza y Cuello , Suiza/epidemiología

RESUMEN

BACKGROUND: The treatment of head and neck squamous cell carcinoma (HNSCC) is highly complex and requires a multimodal approach. However, guidelines for the treatment of most forms of HNSCC do not exist in German-speaking countries with the exception of oral cavity cancer. The aim of this cross-sectional study was to describe the current treatment landscape and infrastructure in German-speaking countries. METHODS: From November 2013 to July 2014, 204 departments of otorhinolaryngology (ORL) in Germany, Austria, and the German-speaking part of Switzerland were contacted and invited to take part in a web-based survey on the treatment of HNSCC. In order to cover the study in its entirety, we published three consecutive papers of which this paper is the first. RESULTS: In all, 62 treatment centers (30.4 %) participated in the survey. These centers included 21 university hospitals, 16 certified cancer centers, and 35 large centers, which diagnose at least 75 HNSCC patients annually. In 91.9 % of all cases, there were outpatient consultation hours (that were monodisciplinary in 61.4 %). A multidisciplinary tumor board was existent in 98.4 % of the cases. Of 62 ORL departments, 50 had a hospital cancer registry, 41 of 62 conducted oncological studies, and 35 of 62 assessed their patients' quality of life. CONCLUSION: The infrastructure of the treatment for HNSCC can be considered mostly well-developed and supports interdisciplinary cooperation. Potential improvements can be made regarding the standardization of tumor boards, the participation in clinical trials, and the availability of cancer registries and the data gathered therein.

Asunto(s)

Instituciones Oncológicas/provisión & distribución , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/terapia , Oncología Médica/estadística & datos numéricos , Grupo de Atención al Paciente/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Austria/epidemiología , Carcinoma de Células Escamosas/diagnóstico , Estudios Transversales , Alemania/epidemiología , Neoplasias de Cabeza y Cuello/diagnóstico , Encuestas de Atención de la Salud , Humanos , Prevalencia , Carcinoma de Células Escamosas de Cabeza y Cuello , Suiza/epidemiología , Resultado del Tratamiento

RESUMEN

BACKGROUND: The EXTREME (Erbitux in First-Line Treatment of Recurrent and Metastatic Head and Neck Squamous Cell Carcinoma) protocol is generally considered the gold standard in palliative first-line treatment. However, there is some disagreement about its effectivity, toxicity, and applicability in daily clinical routine. The purpose of this cross-sectional survey was to describe the palliative treatment offered in German-speaking countries. METHODS: From November 2013 to July 2014, 204 departments of otorhinolaryngology (ORL) in Germany, Austria, and the German-speaking parts of Switzerland were contacted and invited to take part in a web-based survey on the treatment of HNSCC. RESULTS: In all, 62 of 204 treatment centers (30.4 %) participated in the survey. Of these, 58 departments offered palliative systemic therapy to their patients; 19 of 58 (32.8 %) treated patients undergoing palliative chemotherapy in their own ORL departments, while 40 of 58 (69 %) upheld a cooperation with medical oncologists in the same hospital and 24 of 58 (41.4 %) with medical oncologic practices. Many of these treatment centers offered multiple locations for treatment. Of the 58 departments, 56 provided an institutional standard for first-line palliative treatment, 13 for second-line, and two for third-line treatment. In 42 of 58 departments the EXTREME protocol was the institutional standard of care for first-line treatment. Moreover, 12 of 58 departments mentioned an individual protocol and two of 58 the inclusion in clinical trials as their local standard. The assessment of patients who could be treated with the first-line standard ranged from 0 to 95 % with a mean of 44.5 %. CONCLUSION: Palliative systemic therapy seems to be well standardized for first-line treatment, whereas there is little standardization in second- and third-line treatments. A large variation was found regarding the estimate of the applicability of the institutional standard. Reasons for this could be the physicians' individual experience as well as the varying assessment regarding the toxicity of palliative systemic therapy.

Asunto(s)

Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/terapia , Adhesión a Directriz/estadística & datos numéricos , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/terapia , Cuidados Paliativos/estadística & datos numéricos , Cuidados Paliativos/normas , Guías de Práctica Clínica como Asunto , Adulto , Anciano , Austria/epidemiología , Carcinoma de Células Escamosas/diagnóstico , Femenino , Alemania/epidemiología , Adhesión a Directriz/normas , Neoplasias de Cabeza y Cuello/diagnóstico , Encuestas de Atención de la Salud , Humanos , Masculino , Oncología Médica/normas , Persona de Mediana Edad , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Prevalencia , Carcinoma de Células Escamosas de Cabeza y Cuello , Suiza/epidemiología

RESUMEN

In many cases squamous cell carcinoma of the head and neck is already in an advanced stage when initially diagnosed. Despite definitive treatment, loco-regional recurrences and metastases are common and patients ultimately require systemic treatment. Epidermal growth factor receptor (EGFR) inhibitors have proven to significantly prolong survival and have therefore become the first line treatment in recurrent and metastatic squamous cell carcinoma of the head and neck in addition to platinum and 5-FU treatment. Good results have also been reported for EGFR inhibitors in cases where platinum-based treatment has failed. Further strategies, such as salvage surgery, platinum-based chemotherapy, targeted therapy, chemoradiation and reirradiation are currently under investigation to reduce toxicity and improve survival and health-related quality of life.

Asunto(s)

Antineoplásicos/administración & dosificación , Carcinoma de Células Escamosas/terapia , Quimioradioterapia/métodos , Receptores ErbB/antagonistas & inhibidores , Medicina Basada en la Evidencia , Neoplasias de Cabeza y Cuello/terapia , Recurrencia Local de Neoplasia/prevención & control , Humanos , Carcinoma de Células Escamosas de Cabeza y Cuello , Resultado del Tratamiento

RESUMEN

The majority of patients with a squamous cell carcinoma of the head and neck region (HNSCC) initially present in a locally advanced stage of the disease. Despite aggressive protocols in first-line treatment, some of these patients develop locoregional recurrences or metastases and are, in particular, extraordinarily challenging for the multidisciplinary treatment team. Therefore, among resectability and prior therapy, age, performance status and individual expectations of the patient have to be taken into account. Apart from surgical options like salvage surgery, chemotherapy and target therapy as well as reirradiation are possible treatment concepts. Unfortunately, most treatment options offer only little to no survival benefit.

Asunto(s)

Carcinoma/secundario , Carcinoma/terapia , Neoplasias de Cabeza y Cuello/terapia , Oncología Médica/tendencias , Recurrencia Local de Neoplasia/terapia , Humanos , Metástasis Linfática

RESUMEN

The majority of patients with a squamous cell carcinoma of the head and neck present with locally advanced tumors. The first-line treatment of locally advanced tumor stages consists of a combined modality management. Despite these aggressive protocols, many patients develop locoregional recurrences or metastasis and place particularly high demands on the interdisciplinary treatment team. Treatment with a curative intent must be differentiated from a palliative one. In addition to prior treatment, resectability, age and performance status, patient wishes must be taken into consideration in treatment planning, especially considering that most therapies offer little to no overall survival benefit. Salvage surgery, chemo- and target therapies, and reirradiation are head and neck surgeon's and radiooncologist's weapons in the fight against these strong opponents. This review focuses on publications and meeting news from last year and reviews the current status of the clinical application of each treatment modality in recurrent or metastatic head and neck cancer.

Asunto(s)

Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Recurrencia Local de Neoplasia/terapia , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Antineoplásicos/uso terapéutico , Benzodioxoles/uso terapéutico , Carcinoma de Células Escamosas/mortalidad , Cetuximab , Terapia Combinada , Dasatinib , Receptores ErbB/antagonistas & inhibidores , Fluorouracilo/uso terapéutico , Gefitinib , Neoplasias de Cabeza y Cuello/mortalidad , Humanos , Indoles/uso terapéutico , Recurrencia Local de Neoplasia/mortalidad , Cuidados Paliativos , Pirimidinas/uso terapéutico , Pirroles/uso terapéutico , Quinazolinas/uso terapéutico , Quinazolinonas/uso terapéutico , Terapia Recuperativa , Carcinoma de Células Escamosas de Cabeza y Cuello , Sunitinib , Tiazoles/uso terapéutico

RESUMEN

Chatoyant is a tool for the simulation and the analysis of heterogeneous free-space optoelectronic architectures. It is capable of modeling digital and analog electronic and optical signal propagation with mechanical tolerancing at the system level. We present models for a variety of optoelectronic devices and results that demonstrate the system's ability to predict the effects of various component parameters, such as detector geometry, and system parameters, such as alignment tolerances, on system-performance measures, such as the bit-error rate.