Advances in Prevention for Head & Neck Cancer

BUFFALO, NY—Techniques developed over the past 20 years have improved outcomes for patients with head and neck cancers. Speakers at the Surgical Oncology Symposium sponsored by Roswell Park Cancer Institute described new surgical methods that offer further improvement in quality of life and new studies of preventive agents.

“Prevention is possible in head and neck cancers. Leukoplakia, a precancerous condition in the mouth, can be prevented by the use of vitamin A,” said Marshall Urist, MD, professor and director of General Surgery, University of Alabama. “Treatment with vitamin A does not permanently stop leukoplakia. It will return when treatment stops. But it points to a method of preventing precancerous cells from turning into cancer in patients who are at high risk,” he said.

The use of 13-cis-retinoic acid (isotretinoin) at a dose of 1 mg/kg/day for 3 months, has been shown to prevent the development of squamous cell carcinoma of the upper aerodigestive tract. This agent is an isomer of retinoic acid, a metabolite of retinol (vitamin A).

A surrogate endpoint biomarker, tumor growth factor (TGF)-alpha, is being used to track the effectiveness of 13-cis-retinoic acid in current studies.

“In patients who have completed vitamin A therapy, we found that TGF-alpha levels dropped when leukoplakia was effectively treated,” Dr. Urist said. “However, the vitamin A dose offered has many side effects and cannot be maintained indefinitely. When stopped, the leukoplakia returned, and TGF-alpha levels rose again.”

A new trial is using the same 3-month treatment with a follow-up maintenance dose of 0.25 mg/kg/day for 9 months. “This is a first step toward reversing cellular changes that lead to cancer,” he said.

For patients who do progress to head and neck cancer, new surgical methods have improved treatment and overall survival, said J. Edward Young, MD, head of surgical oncology, Hamilton Regional Cancer Center and McMaster University, Hamilton, Ontario.

“Recent advances in head and neck reconstruction after radical cancer surgery offer patients excellent outcomes without the need for multistage surgical reconstruction,” Dr. Young said. This advance has been made possible by “free flap” techniques that allow the surgeon to transfer skin, muscle, and bone from remote surgical sites and then reestablish the blood supply to this new tissue in the head and neck with microscopic small vessel anastomoses.

“This has had a tremendous impact on our ability to resect and rehabilitate patients with advanced head and neck cancer,” Dr. Young said.

One particular surgery that has benefited from free flap techniques is the reconstruction of the mandible.

 “In particular, a major change in the past 20 years has been the ability to reconstruct the anterior mandible with well-vascularized bone from the leg, arm, ribs, or hip to provide excellent contour and function. In some cases, this technique even allows for dental implants,” Dr. Young said.