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Critical Issues in Head and Neck Oncology

Key Concepts from the Eighth THNO Meeting

• Jan B. Vermorken 0 ,
• Volker Budach 1 ,
• C. René Leemans 2 ,
• Jean-Pascal Machiels 3 ,
• Piero Nicolai 4 ,
• Brian O'Sullivan 5

Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium

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Departments for Radiation Oncology, Charité-University Medicine Berlin, Berlin, Germany

Department of otolaryngology-head and neck surgery, amsterdam university medical centre, amsterdam, the netherlands, department of medical oncology, cliniques universitaires saint-luc, brussels, belgium, section of otorhinolaryngology-head and neck surgery, department of neurosciences, azienda ospedale università di padova, university of padova, padova, italy, department of radiation oncology, princess margaret cancer centre, university of toronto, toronto, canada.

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• Multidisciplinary management of head and neck cancer

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Table of contents (22 papers), front matter, the bi-directional communication between tumour cells and other components of the tumour microenvironment.

• Philip Sloan

Immune Checkpoint Inhibition and Radiotherapy in Head and Neck Squamous Cell Carcinoma: Synergisms and Resistance Mechanisms

• Nikko Brix, Kirsten Lauber

DNA Repair Mechanisms as a New Target in Head and Neck Cancer

• Kevin J. Harrington, Charleen M. L. Chan Wah Hak, Antonio Rullan, Emmanuel Patin

How to Standardize Molecular Profiling Programs for Routine Patient Care

• Ingeborg Tinhofer, Ulrich Keilholz, Damian Rieke

Novel Immune Oncology Targets Beyond PD-1/PD-L1 in Head and Neck Cancer

• Edith Borcoman, Christophe Le Tourneau

Understanding Head and Neck Cancer Evolution to Guide Therapeutic Approaches

• Ben O’Leary

Sensitivity and Specificity of Extranodal Extension: Unlocking One of the Strongest Prognostic Factors in Head and Neck Cancer

• Shao Hui Huang, Ionut Busca, Eugene Yu, Ezra Hahn, Brian O’Sullivan

Proton Therapy for Head and Neck Cancer

• V. Budach, A. Thieme

Treatment De-Escalation of HPV-Positive Oropharyngeal Cancer—Lessons Learnt from Recent Trials

• Hisham Mehanna

Treatment Intensification in Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: What Are the Options and for Whom?

Jan B. Vermorken

Immune Checkpoint Inhibitors in the Curative Setting: Pre-clinical and Clinical Data

• Simon Beyaert, Natasha Honoré, Jean-Pascal Machiels

Carcinoma of Unknown Primary: Diagnostics and the Potential of Transoral Surgery

• Stijn van Weert, Jan-Jaap Hendrickx, C. René Leemans

Systemic Treatment Sequencing and Prediction of First-line Therapy Outcomes in Recurrent or Metastatic Head and Neck Cancer

• Petr Szturz, Jan B. Vermorken

Patterns of Response to Immune Oncology Drugs: How Relevant Are They in SCCHN?

• Panagiota Economopoulou, Amanda Psyrri

Stereotactic Body Radiation Therapy in the Management of Recurrent and/or Oligometastatic Head and Neck Cancer

• Daan Nevens, Petr Szturz

Precision Medicine in the Treatment of Malignancies Involving the Ventral Skull Base: Present and Future

• Marco Ferrari, Stefano Taboni, Giacomo Contro, Piero Nicolai

Modern Day Reconstruction of the Facial Bones

• David McGoldrick, Prav Praveen, Sat Parmar

Targeting Molecular Residual Disease Using Novel Technologies and Clinical Trials Design in Head and Neck Squamous Cell Cancer

• Enrique Sanz-Garcia, Lillian L. Siu

New Developments in Surgery for Malignant Salivary Gland Tumors

• J. Meulemans, C. Van Lierde, P. Delaere, J. J. Vranckx, V. Vander Poorten
• Head and Neck Cancer
• Predictive markers
• Non-orophayngeal head and neck cancer
• Induction chemotherapy
• Radiation Oncology
• Surgical Oncology
• Liquid biopsies
• Precision medicine
• Nasopharynx cancer
• Immunotherapy
• Personalized Medicine

Volker Budach

C. René Leemans

Jean-Pascal Machiels

Piero Nicolai

Brian O'Sullivan

Prof. Jan B. Vermorken, MD, PhD, started his medical training in 1961, graduated in 1970 from the University of Amsterdam, the Netherlands, and became a board-certified specialist in internal medicine in 1975. Since that time he has worked in the field of Medical Oncology and was officially registered as a Medical Oncologist in the Netherlands in 1992. He received his PhD in Medical Sciences in 1986 from the Vrije Universiteit in Amsterdam. From May 1997 until October 1, 2009, he was appointed Professor of Oncology at the University of Antwerp (UA), in Antwerp, Belgium and head of the Department of Medical Oncology at the University Hospital Antwerp (UZA), in Edegem, Belgium. After his retirement he remained connected to both University (Emeritus Professor) and University Hospital (consultant). His main fields of interest are head and neck oncology and gynecologic oncology. He chaired both the Head and Neck Cancer Group (2006-2009) and the Gynecologic Cancer Group (1983-1989) of theEuropean Organization for the Research and Treatment of Cancer (EORTC). He was founding chair of the Gynecologic Cancer InterGroup (GCIG: 1997-2003) and strongly involved in establishing the Head and Neck Cancer International Group (HNCIG) in 2015.

Professor Vermorken is member of various scientific societies, member of several editorial boards of International journals, reviewer of multiple cancer journals and author or co-author of more than 700 publications. He was Editor-in-Chief of Annals of Oncology from 2009 to 2014 and is chief editor of the head and neck cancer section of The Oncologist (since 2003), and the head and neck section of Frontiers in Oncology (since 2015), is editorial chair of ONCOhemato (multidisciplinary journal; since 2007) in Belgium and chaired Oncotherapie (an internet platform) in The Netherlands (2007-2020). He received the ESMO award in 2007 and on March 1, 2013 he received the title of Commander in the Order of Leopold for his contributions to oncology.

Prof. Volker Budach, MD, is Head of the Departments of Radiation Oncology at the Charité University Medicine Berlin. He became a board-certified radiologist in 1985 and radiation oncologist in 1988 at the University of Essen and was appointed as full professor and chair of the Department for Radiation Oncology at the Charité University Clinics, Campus-Mitte in 1993. He was the founder and the head of the Tumor center Berlin (1994-2011). He was a board member and treasurer of the European Society for Radiotherapy and Oncology (ESTRO) from 1996 till 2004 and chairman of the EORTC Radiation Oncology Group (ROG) from 2000 till 2003, followed by an “executive board” membership of the EORTC and chairman of the "Clinical Research Division" of the EORTC (2003-2006). He was a board member and president of the German Society for Radiation Oncology (DEGRO) from 2005 till 2011. He was a founding member and chair of the German Cooperative Interdisciplinary soft tissue sarcoma group(IAWS)(2006-2012) and a founding and board member of the German Interdisciplinary Head and Neck Group (2008-2019) of the German Cancer Society (DKG). He was additionally appointed as chair of the Department for Radiation Oncology at the Charité-University Medicine Berlin, Campus-Virchow in 2006, and also appointed as chair of the department of Radiation Oncology at the Campus Benjamin-Franklin in 2014. He was a member of the German interdisciplinary Guideline Commissions on Diagnosis, Treatment and Follow-up for breast cancer (2015 until now) and anal cancer (2019-2020). He is a member of many international oncologic societies (e.g. ASCO, ASTRO, ESTRO) and Principle Investigator of several studies in head and neck cancer. He received in 2022 the ESTRO Lifetime Achievement Award and the DEGRO Medal as a founding member of the German Society for Radiation Oncology. He was an author or co-author in 396 publications (PubMed, 10/22).

Professor C. René Leemans, MD, PhD is chair ofthe Department of Otolaryngology Head and Neck Surgery at the Amsterdam University Medical Centres, VUmc, Amsterdam. He is Director of the Advanced Fellowship Program in Head and Neck Surgery and Oncology at the VU University Medical Centre Amsterdam. His special interests include head and neck oncology, reconstructive and microvascular surgery, and basic research. René Leemans has made a sustained and internationally recognized contribution to cancer care and research in the field of head and neck oncology over the past decades. His scientific standing has been recognized by election as President of the Netherlands Society of Otolaryngology-Head and Neck Surgery, and the Dutch and European Head and Neck Societies. He also serves on the Leadership of the American Head and Neck Society (AHNS). He (co-)authored more than 400 papers and book chapters on head and neck oncology and is regularly invited to speak at international conferences and tutor at courses. He leads the successful MakeSense Awareness Campaign.

Professor Jean-Pascal Machiels MD, PhD, is head of department of medical oncology and director of the Institut Roi Albert II Cancer centre, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels Belgium. He trained at Université Catholique de Louvain, Brussels, Belgium, where he gained his MD in 1993 and his PhD in 2001 and at Johns Hopkins School of Medicine, Baltimore USA, where he was a Fellow in Medical Oncology from 1998 until 2000. His main interests include Head and Neck cancer, and phase 1 clinical trials. He has published more than two hundred papers reporting on clinical trials and translational research

Professor Piero Nicolai, MD, is Head of the Section of Otorhinolaryngology – Head and Neck Surgery, Department of Neurosciences, at the Azienda Ospedale Università di Padova and Professsor of Otorhinolaryngology at the University of Padova. From 2006 to 2019 he has served as Professor and Chairmanof the Unit of Otorhinolaryngology – Head and Neck Surgery at ASST Spedali Civili Brescia - University of Brescia. He received his MD degree at the University of Padova, where he completed his residency program in Otorhinolaryngology and subsequently in Oncology. His clinical and research activities are mainly focused on head and neck oncology and endoscopic sinus and skull base surgery. Prof. Nicolai has authored or co-authored 389 papers in peer-reviewed journals as well as 61 book chapters. He has been co-editor of 6 books, and Editor of 6 issues of Current Opinion in Otolaryngology & Head and Neck Surgery on Head and Neck Oncology. He is a member of the editorial board of the journals Annals of Otology, Rhinology & Laryngology, Head and Neck, International Journal of Head & Neck Surgery, The Laryngoscope, and Associate Editor of Frontiers in Oncology – Head and Neck Cancer Section.

Professor Brian O’Sullivan, MD, is the inaugural Bartley-Smith/Wharton Chair (Emeritus) inRadiation Oncology and immediate past Chair of the Head and Neck Program at the Princess Margaret Cancer Centre, University of Toronto. He has Co-chaired the Head and Neck Steering committee of the US National Cancer Institute and is Editor-in Chief of the UICC Manual of Clinical Oncology, Chair of the UICC Prognostic Factors Classification Committee, Chair of the UICC Head and Neck Committee, and co-editor of the UICC TNM Classification of Malignant Tumours and Liaison to the AJCC Expert Committee on Head and Neck Cancer. He is also a recognized expert in the management of sarcoma and a past-President of the Connective Tissue Oncology Society (CTOS). He has published more than 700 manuscripts more than 460 of which are peer-reviewed. Professor O’Sullivan has received some of the top awards in radiation oncology including the Juan A del Regato Gold Medal, the award of Honor of the Radiological Society of North America, and the American Society of Radiation Oncology (ASTRO) Gold Medal.

Book Title : Critical Issues in Head and Neck Oncology

Book Subtitle : Key Concepts from the Eighth THNO Meeting

Editors : Jan B. Vermorken, Volker Budach, C. René Leemans, Jean-Pascal Machiels, Piero Nicolai, Brian O'Sullivan

DOI : https://doi.org/10.1007/978-3-031-23175-9

Publisher : Springer Cham

eBook Packages : Medicine , Medicine (R0)

Copyright Information : The Editor(s) (if applicable) and The Author(s) 2023

Hardcover ISBN : 978-3-031-23174-2 Published: 28 March 2023

Softcover ISBN : 978-3-031-23177-3 Published: 28 March 2023

eBook ISBN : 978-3-031-23175-9 Published: 27 March 2023

Edition Number : 1

Number of Pages : IX, 365

Number of Illustrations : 7 b/w illustrations, 58 illustrations in colour

Topics : Oncology , Imaging / Radiology , Cancer Research

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Key Concepts from the Seventh THNO Meeting

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Dissertations / Theses on the topic 'Head and neck cancer ; radiotherapy'

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Beasley, William. "Optimising adaptive radiotherapy for head and neck cancer." Thesis, University of Manchester, 2017. https://www.research.manchester.ac.uk/portal/en/theses/optimising-adaptive-radiotherapy-for-head-and-neck-cancer(96e831b0-751a-454d-8a6d-4dd490b6a88f).html.

Bhide, Shreeang Arvind. "Optimization of intensity modulated radiotherapy in head and neck cancer." Thesis, Institute of Cancer Research (University Of London), 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.511161.

Lei, Mary Wei-Ching. "Image guided intensity modulated radiotherapy in head and neck cancer." Thesis, University of Surrey, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.600034.

Leslie, Martin David. "Salivary gland function after radiotherapy for head and neck cancer." Thesis, University College London (University of London), 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.341706.

Andrews, Nigel Anthony. "Intrinsic cellular radiosensitivity in head and neck cancer." Thesis, University of Liverpool, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367189.

Patterson, Joanne Margaret. "Swallowing in head and neck cancer patients treated by (chemo) radiotherapy." Thesis, University of Newcastle Upon Tyne, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.545765.

Ho, Kean Fatt. "Optimising dose escalated intensity modulated radiotherapy (IMRT) in head and neck cancer." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.508596.

Ramadaan, Ihab Safa. "Validation of Deformable Image Registration for Head & Neck Cancer Adaptive Radiotherapy." Thesis, University of Canterbury. Physics and Astronomy, 2013. http://hdl.handle.net/10092/8083.

Tang, Nin-fai Francis, and 鄧年輝. "Monte Carlo dose calculations in quality assurance for IMRT of head and neck cancers." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B40203797.

Chan, Sze-man, and 陳詩敏. "A clinical guideline to manage radiotherapy induced oral mucositis in head and neck cancer patients." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B44622934.

Newbold, Katie Lindsay. "The application of advanced imaging techniques to radiotherapy planning in head and neck cancer." Thesis, Institute of Cancer Research (University Of London), 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.498512.

Berthon, Beatrice. "Optimisation of Positron Emission Tomography based target volume delineation in head and neck radiotherapy." Thesis, Cardiff University, 2014. http://orca.cf.ac.uk/69184/.

Kuo, Michael Jeo-Ming. "Aberrations of chromosome arms 5q and 8p in squamous cell carcinomas of the head and neck." Thesis, University of Birmingham, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.340558.

Ryalat, Mohammad. "Automatic construction of immobilisation masks for use in radiotherapy treatment of head-and-neck cancer." Thesis, University of East Anglia, 2017. https://ueaeprints.uea.ac.uk/66573/.

Pow, Ho-nang Edmond, and 鮑浩能. "Oral health and quality of life after intensity-modulated head and neck radiotherapy for nasopharyngeal carcinoma." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B4501565X.

Nguyen, Nam, Paul Vos, Vincent Vinh-Hung, Misty Ceizyk, Lexie Smith-Raymond, Michelle Stevie, Benjamin Slane, et al. "Feasibility of image-guided radiotherapy based on helical tomotherapy to reduce contralateral parotid dose in head and neck cancer." BioMed Central, 2012. http://hdl.handle.net/10150/610349.

Goodall, Benjamin David. "An exploration of the experience of undergoing radiotherapy for head and neck cancer patients : a biopsychosocial approach." Thesis, University of Hull, 2007. http://hydra.hull.ac.uk/resources/hull:15098.

Lochner, Johann Georg. "A comparison of two saliva substitutes in the management of xerostomia during radiotherapy for cancer of the head and neck." Thesis, University of the Western Cape, 2007. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_9540_1257166768.

The aim of the study is to compare the palliative efficacy of two saliva substitutes (Sinspeek and Xerostom) in patients during radiotherapy for cancer of the head and neck. This crossover randomised controlled clinical trial was carried out on twenty-five patients with malignant tumours of the head and neck, following four weeks of radiotherapy at tygerberg hospital. The benefit of saliva substitutes to ameliorate the effects of xerostomia is well established and proper advice and access to relevant preparations is essential.

Marcu, Loredana Gabriela. "Deterministic modelling of kinetics and radiobiology of radiation-cisplatin interaction in the treatment of head and neck cancers." Title page, contents and abstract only, 2004. http://hdl.handle.net/2440/37961.

Rodrigues, Joana de Matos. "From genes to radioresistance in head and neck squamous cell carcinoma." Master's thesis, Universidade de Aveiro, 2015. http://hdl.handle.net/10773/16133.

Kawamura, Mitsue. "A scoring system predicting acute radiation dermatitis in patients with head and neck cancer treated with intensity-modulated radiotherapy." Kyoto University, 2019. http://hdl.handle.net/2433/244519.

Satherley, Thomas William Scott. "The impact of plan complexity on the accuracy of VMAT for the treatment of head and neck cancer." Thesis, University of Canterbury. Physics, 2015. http://hdl.handle.net/10092/10584.

De, Pomeroy-Legg Jeanita. "Prevalence of side-effects and change in nutritional status during radical radiotherapy for head and neck malignancies at Tygerberg Academic Hospital, Western Cape, South Africa." Thesis, Link to the online version, 2008. http://hdl.handle.net/10019/1492.

Helal, Azza Mahmoud. "The effect of patient anatomy on optimised intensity modulated radiotherapy dose distributions for head and neck and prostate cancer." Thesis, University of Nottingham, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.438639.

Gulati, Shuchi. "Phase-1 Study of Metformin in Combination with Concurrent Cisplatin and Radiotherapy in Patients with Locally Advanced Head and Neck Cancer." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1593171585877322.

Nutting, Christopher. "Can intensity-modulated radiotherapy (IMRT) be used to reduce toxicity and improve tumour control in patients with head and neck cancer?" Thesis, City University London, 2012. http://openaccess.city.ac.uk/1128/.

Zziwa, Aloysious. "A RADIOTHERAPY PLAN SELECTOR USING CASE-BASED REASONING." Master's thesis, Temple University Libraries, 2010. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/85055.

Larsson, Maria. "Eating problems in patients with head and neck cancer treated with radiotherapy : Needs, problems and support during the trajectory of care." Doctoral thesis, Karlstad University, Faculty of Social and Life Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-777.

Aim: The overall aim of this thesis was to acquire knowledge about daily life with focus on eating problems during the trajectory of care for patients with head and neck cancer treated with radiotherapy. Method: The data in study I were gained from medical and nursing records of 50 patients. Documented parameters of eating problems, their causes and consequences, and undertaken interventions were collected before treatment, during radiotherapy, and one, six, and twelve months after completion of treatment, using a study-specific audit instrument. Data were analysed with descriptive and inferential non-parametric statistics. In study II eight patients were interviewed during the radiotherapy treatment period with focus on experiences of eating problems. In study III nine patients were interviewed six to twelve weeks after treatment with the focus on experiences of daily life during the trajectory of care having eating problems. In study IV twelve patients were interviewed about their conceptions of the significance of a supportive nursing care clinic during the whole trajectory of care. Data were analysed with interpretative phenomenology (II, III) and phenomenography (IV). Findings: The four studies showed that being a patient in the trajectory of care often meant that life was disturbed and threatened. This was partly due to the eating problems and their consequences, which could occur during the whole trajectory of care (I, III, IV) but was experienced as most intense and severe during radiotherapy (II) and the nearest weeks after completion of radiotherapy (III, IV). The disturbances and threats experienced due to eating problems could affect the whole person as they were physical (I-IV), psychological, social and existential (II, III). The experiences of eating problems due to the tumour and its treatment and the experience of having cancer per se were strongly connected as one phenomenon, which disturbed and threatened the informants’ daily life. The other part that disturbed the patients’ life was the waiting in suspense. A long and trying waiting in uncertainty was experienced due to lack of knowledge and support, practical as well as emotional. This was most pronounced during pauses in radiotherapy (III) and after completion of the treatment when the lack of support from the health care was obvious (I, II, III). The patients were then most often left to their own devices. In order to endure, they needed both inner strength, described as own coping strategies, and strength from outside, described as support from family, friends and health care professionals (II, III). The nurse clinic was found to give a hand to hold during the whole trajectory of care (IV). It could meet these patients’ needs of knowledge, care and support, both concerning practical measures related to the eating problems and other side-effects of the treatment, and concerning their emotional needs. In addition the nurse clinic could support the relatives in their worries and anxiety (IV). Conclusion: This thesis showed the necessity of continuous assessment, treatment and evaluation of patients’ problems, and the patients’ needs of information and support throughout the trajectory of care.

Sun, Aijun. "Radiolabeled acetate PET in oncology imaging studies on head and neck cancer, prostate cancer and normal distribution /." Doctoral thesis, Umeå : Umeå university, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-32980.

Silva, Ana Margarida Abreu Rodrigues da. "A radioterapia em patologia oncológica de cabeça e pescoço: impacto na qualidade de vida e na saúde oral." Master's thesis, [s.n.], 2012. http://hdl.handle.net/10284/3407.

Conibear, John Richard. "Assessment of target volume and organ at risk contouring variability within the context of UK head and neck and lung cancer radiotherapy clinical trials." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10045105/.

Georgi, Alexander. "Lokal fortgeschrittene Kopf-Hals-Tumoren- Eine retrospektive, monoinstitutionale Studie zur Beurteilung der postoperativen Radiochemotherapie im klinischen Alltag." Doctoral thesis, Universitätsbibliothek Leipzig, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-130129.

Albuquerque, Danielle Frota de. "Avaliação dos parâmetros de halitose e sialometria em pacientes submetidos à radioterapia de cabeça e pescoço." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/25/25132/tde-14062007-132546/.

Alencar, Anelise Ribeiro Peixoto. "Tratamento da mucosite oral radio e quimioinduzida: comparação entre protocolo medicamentoso convencional e tratamentos com lasers em baixa intensidade." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/85/85134/tde-01072011-131133/.

Tehrany, Narges [Verfasser], Peter [Akademischer Betreuer] Burfeind, Holger [Akademischer Betreuer] Reichardt, and Andreas Pd [Akademischer Betreuer] Wolff. "Importance of CXCL12 and CXCR4 in radiotherapy of head and neck cancer, considering the association with HPV-infection / Narges Tehrany. Gutachter: Holger Reichardt ; Andreas Pd Wolff. Betreuer: Peter Burfeind." Göttingen : Niedersächsische Staats- und Universitätsbibliothek Göttingen, 2015. http://d-nb.info/1076398715/34.

Castelli, Joël. "Radiothérapie adaptative morphologique et métabolique des cancers ORL." Thesis, Rennes 1, 2017. http://www.theses.fr/2017REN1B043/document.

Pereira, Raony Môlim de Sousa. "Efeito de uma formulação farmacêutica de pilocarpina em pacientes com xerostomia: estudo randomizado, controlado, duplo-cego e crossover." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/58/58131/tde-04092017-081856/.

Gonçalves, Liliana Maria do Vale Costa. "Avaliação do pH salivar em pacientes submetidos a radioterapia à região de cabeça e pescoço." Master's thesis, [s.n.], 2015. http://hdl.handle.net/10284/5245.

Campos, Renata Jacob Daniel Salomão de. "Preservação de órgãos em cânceres de cabeça e pescoço: análises da qualidade de vida e parâmetros vocais pós-tratamento." Universidade Federal de Juiz de Fora (UFJF), 2009. https://repositorio.ufjf.br/jspui/handle/ufjf/3894.

Pereira, Raony Môlim de Sousa. "Aspectos sociais e de saúde bucal, qualidade de vida, xerostomia e fluxo salivar em pacientes tratados com radioterapia para neoplasias na região da cabeça e pescoço." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/58/58131/tde-14122015-093705/.

Sabino-Bezerra, José Ribamar 1986. "Evaluation of an educational video to improve the understanding of radiotherapy side effects in head and neck cancer patients = Avaliação de vídeo educacional para melhoria da compreensão dos efeitos colaterais associados à radioterapia em pacientes com câncer de cabeça e pescoço." [s.n.], 2013. http://repositorio.unicamp.br/jspui/handle/REPOSIP/287865.

Martins, Rebecca Feilenberger de Oliveira. "EFEITOS A MÉDIO PRAZO DA RADIOTERAPIA NA DENSIDADE ÓSSEA DOS MAXILARES DE PACIENTES COM CÂNCER DE CABEÇA E PESCOÇO." Pontifícia Universidade Católica de Goiás, 2006. http://localhost:8080/tede/handle/tede/3037.

Coliat, Pierre. "Stratégie de sensibilisation des tumeurs des voies aérodigestives supérieures aux anti-EGFR et résistance induite : induction de HIF-2 et opportunité thérapeutique." Thesis, Strasbourg, 2015. http://www.theses.fr/2015STRAJ067/document.

Benavente, Norza Sergio. "Avaluació de factors mol·leculars associats a la resposta a anticossos monoclonals anti-EGFR: integració amb tractaments de radioteràpia en càncer de cap i coll." Doctoral thesis, Universitat Autònoma de Barcelona, 2016. http://hdl.handle.net/10803/378365.

Ghazali, N. "Personalising head and neck cancer survivorship : intervention with the Head and Neck Cancer Patients Concerns Inventory in routine head and neck cancer outpatient visits." Thesis, University of Liverpool, 2018. http://livrepository.liverpool.ac.uk/3020175/.

Blanchard, Pierre. "Méta-analyses sur données individuelles d’essais randomisés dans les cancers des voies aéro-digestives supérieures. Développements méthodologiques et cliniques." Thesis, Paris 11, 2013. http://www.theses.fr/2013PA11T065/document.

Gluck, Caitlin, and Caitlin Gluck. "HPV Mediated Head and Neck Cancer." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/621127.

Winter, Stuart Charles Alec. "Hypoxia in head and neck cancer." Thesis, University of Bristol, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.428506.

Ostyn, Mark R. "Reducing Uncertainty in Head and Neck Radiotherapy with Plastic Robotics." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5558.

Lacas, Benjamin. "Apport clinique des méta-analyses dans les cancers ORL localement avancés." Thesis, université Paris-Saclay, 2020. http://www.theses.fr/2020UPASS054.

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Effect of human beta-defensin-3 on head and neck cancer cell migration using micro-fabricated cell islands

To examine the effect of the natural antimicrobial peptide human β-defensin-3 (hBD-3), on the migration of a head and neck cancer cell line in vitro using microfabrication and soft-lithographic techniques.

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Feasibility of recruitment to an oral dysplasia trial in the United Kingdom

Oral epithelial dysplasia (OED) has a malignant potential. Therapeutic options for OED remain both limited and without good evidence. Despite surgery being the most common method of treating OED, recurrence an...

Spinal metastasis in thyroid cancer

Thyroid carcinoma generally responds well to treatment and spinal metastasis is an uncommon feature. Many studies have looked at the management of spinal metastasis and proposed treatments, plans and algorithm...

p16 overexpression in malignant and premalignant lesions of the oral and esophageal mucosa following allogeneic hematopoietic stem cell transplantation

Secondary malignancy in the oral mucosa is recognized as one of the most serious complications in patients who received allogenic hematopoietic stem cell transplantation (HSCT). However, potential risk factors...

Analysis of the compatibility of dental implant systems in fibula free flap reconstruction

As a result of major ablative surgery, head and neck oncology patients can be left with significant defects in the orofacial region. The resultant defect raises the need for advanced reconstruction techniques....

Spinal metastasis in head and neck cancer

The incidence of head and neck cancer is relatively low in developed countries and highest in South East Asia. Notwithstanding advances in surgery and radiotherapy over the past several decades, the 5-year sur...

Granulocyte colony-stimulating factor-producing squamous cell carcinoma of the lower gingiva: a case report

The present study summarizes our experience in treating a patient with a suspected granulocyte colony-stimulating factor (G-CSF)-producing squamous cell carcinoma (SCC) of the lower gingiva, which is a rather ...

Positron emission tomography in the detection of occult primary head and neck carcinoma: a retrospective study

The management of cervical lymph node metastases from an unknown primary tumor remains a controversial subject. Recently, Positron Emission Tomography (PET) has proved useful in the detection of these tumors, ...

A patient with primary Burkitt’s lymphoma of the postnasal space: case report

Burkitt’s lymphoma is a highly aggressive lymphoma. The endemic form is present with Epstein - Barr virus. The most common sites are the mandible, facial bones, kidneys, gastrointestinal tract, ovaries, breast...

Enhanced patient reported outcome measurement suitable for head and neck cancer follow-up clinics

The ‘Worse-Stable-Better’ (W-S-B) question was introduced to capture patient-perceived change in University of Washington Quality of Life (UW-QOL) domains.

Oral sex, cancer and death: sexually transmitted cancers

We briefly highlight the growing body of recent evidence linking unprotected oral sex with the development of some types of head and neck cancer in younger patients. These tumours appear to be increasing in in...

Solitary giant neurofibroma of the neck subjected to photodynamic therapy: case study

Photodynamic therapy (PDT) - the fourth modality - has been successfully used in the management of early and advanced pathologies of the head and neck. We studied the effect of this modality on a giant solitar...

Structural validation of oral mucosal tissue using optical coherence tomography

Optical coherence tomography (OCT) is a non-invasive optical technology using near-infrared light to produce cross-sectional tissue images with lateral resolution.

Squamous cell carcinoma of the oral cavity and the oropharynx in patients less than 40 years of age: a 20-year analysis

Squamous cell carcinoma mainly afflicts patients older than 40 years of age however, few cases are seen in younger patients. The aim of this study therefore was to determine the incidence of squamous cell carc...

Metastatic rhabdomyosarcoma of the thyroid gland, a case report

The thyroid gland is a known but an unusual site for metastatic tumors from various primary sites. Despite the fact that it is one of the largest vascular organs in the body, clinical and surgical cases have g...

Computed tomography and pathological findings of five nasal neurilemmomas

Neurilemmomas are benign tumors deriving from Schwann cells of the nerve sheath. They occur in all parts of the body. The highest incidence of neurilemmoma is in the head and neck region (38–45%), but involvem...

A patient with ulcerated calcifying epithelioma of Malherbe in the pinna: case report

Although pilomatrixomas are frequently encountered by dermatologists and pathologists in the differential diagnosis of head and neck lesions, this is not usually the case among head and neck surgeons.

Branchial cysts within the parotid salivary gland

Cystic lesions within the parotid gland are uncommon and clinically they are frequently misdiagnosed as tumours. Many theories have been proposed as to their embryological origin. A 20-year retrospective revie...

Definitive radiotherapy for early stage glottic cancer by 6 MV photons

To evaluate the clinical outcome of early glottic cancer (GC) treated by primary radiotherapy (RT) with 6 MV photons.

The use of specific anti-growth factor antibodies to abrogate the oncological consequences of transfusion in head & neck squamous cell carcinoma: an in vitro study

Perioperative blood transfusion is associated with reduced prognosis in a number of solid malignancies. We investigate its role in a head & neck squamous cell cancer (HNSCC) cell lines. Growth of these cell li...

Reconstruction of scalp defects with the radial forearm free flap

Advanced and recurrent cutaneous squamous cell carcinoma of the scalp and forehead require aggressive surgical excision often resulting in complex defects requiring reconstruction. This study evaluates various...

Tongue cancer in young patients: case report of a 26-year-old patient

This article presents the case of a 26-year-old woman with tongue cancer. The median age at the diagnosis of the tongue’s cancer is 61 years. Only approximately 2% of patients are diagnosed before the age of 35.

Systemic therapy in the management of metastatic or advanced salivary gland cancers

Salivary gland cancers are very rare tumors. They are characterized by a histologic heterogeneity and a poor outcome. According to this rarity, few prospective data are available to date. No standard recommend...

Expression of Glut-1, HIF-1α, PI3K and p-Akt in a case of ceruminous adenoma

Ceruminous adenoma of the external auditory canal (EAC) is a rare type of tumour that is diagnosed histologically. However, the clinical behaviour of these tumours remains controversial. Here, we report a case...

CO2 lasers in the management of potentially malignant and malignant oral disorders

The CO 2 laser was invented in 1963 by Kumar Patel. Since the early 1970s, CO 2 laser has proved to be an effective method of treatment for patients with several types of oral lesions, including early squamous cell...

Photodynamic therapy in the management of potentially malignant and malignant oral disorders

Photodynamic therapy (PDT) is a minimally-invasive surgical tool successfully targeting premalignant and malignant disorders in the head and neck, gastrointestinal tract, lungs and skin with greatly reduced mo...

The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, medicare, and medicaid

Head and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, ...

Delay in pathological tissue processing time vs. mortality in oral cancer: Short communication

Several factors have been identified to affect morbidity and mortality in oral cancer patients. The time taken to process a resected cancer specimen in a patient presenting with primary or recurrent disease ca...

Clear cell chondrosarcoma of the head and neck

Clear cell chondrosarcoma is a rare variant of chondrosarcoma that mostly involves the end of long bones. However, nine cases have been reported in the head and neck: four in larynx, two in nasal septum, two i...

A retrospective, deformable registration analysis of the impact of PET-CT planning on patterns of failure in stereotactic body radiation therapy for recurrent head and neck cancer

Stereotactic body radiation therapy (SBRT) has seen increasing use as a salvage strategy for selected patients with recurrent, previously-irradiated squamous cell carcinoma of the head and neck (rSCCHN). PET-C...

Knockdown of aberrantly expressed nuclear localized decorin attenuates tumour angiogenesis related mediators in oral cancer progression model in vitro

Oral cancer accounts for roughly 3% of cancer cases in the world with about 350,000 newly reported cases annually and a 5-year survival rate of only 50%. Majority of oral cancers are squamous cell carcinomas t...

Parapharyngeal space hemangiopericytoma treated with surgery and postoperative radiation- a case report

Hemangiopericytoma (HPC) is a rare tumor of uncertain malignant potential arising from mesenchymal cells with pericytic differentiation. It accounts for 3-5% of soft tissue sarcomas and 1% of vascular tumors. ...

The prognostic significance of p63 and Ki-67 expression in myoepithelial carcinoma

Myoepithelial carcinoma is a rare tumour. The clinical and biological behaviours of these tumours are variable. Although many factors have been evaluated as potential prognostic indicators, including clinical ...

Primary squamous cell carcinoma of thyroid: a case report and review of literature

Thyroid gland lacks squamous epithelium (except in some rare situations like embroyonic remnants or in inflammatory processes); for that reason the primary squamous cell carcinoma (SCC) of thyroid is extremely...

Nimesulide inhibited the growth of hypopharyngeal carcinoma cells via suppressing Survivin expression

The objective of this study was to evaluate the efficacy of Nimesulide, a selective cyclooxygenase-2 (COX-2) inhibitor, on the growth of hypopharyngeal carcinoma cells (FaDu) in vitro, and investigate its pote...

The effect of tobacco and alcohol and their reduction/cessation on mortality in oral cancer patients: short communication

The use of tobacco is known to increase the incidence of developing oral cancer by 6 times, while the additive effect of drinking alcohol further increases the risk leading to higher rate of morbidity and mort...

cTNM vs. pTNM: the effect of not applying ultrasonography in the identification of cervical nodal disease

Accurate clinical staging of oral squamous cell cancer can be quite difficult to achieve especially if nodal involvement is identified. Radiologically-assisted clinical staging is more accurate and informs the...

Etiology analysis and computed tomography imaging of a tonsillar inflammatory myofibroblastic tumor: report of an immunocompetent patient and brief review

The etiology of Inflammatory myofibroblastic tumor(IMT) is contentious. In this study, we used computed tomography (CT) to examine tonsillar IMT and further analyzed the etiology of this entity.

A decision support system for quality of life in head and neck oncology patients

The assessment of Quality of Life (QoL) is a Medical goal; it is used in clinical research, medical practice, health-related economic studies and in planning health management measures and strategies. The obje...

Randomized clinical trial of LigaSure versus conventional suture ligation in thyroid surgery

In thyroid surgery vessel division and haemostasis make up an important and time consuming part of the operation. While the presence of the recurrent laryngeal nerve limits the liberal use of diathermia, the m...

A review of the epidemiology of oral and pharyngeal carcinoma: update

Oral and pharyngeal cancers are the sixth most common cancers internationally. In the United States, there are about 30,000 new cases of oral and pharyngeal cancers diagnosed each year. Furthermore, survival r...

The impact of frozen sections on final surgical margins in squamous cell carcinoma of the oral cavity and lips: a retrospective analysis over an 11 years period

Taking intraoperative frozen sections (FS) is a widely used procedure in oncologic surgery. However so far no evidence of an association of FS analysis and premalignant changes in the surgical margin exists. T...

Vascular mimicry in cultured head and neck tumour cell lines

Vascuologenesis is the de novo establishment of blood vessels and vascular networks from mesoderm-derived endothelial cell precursors (angioblasts). Recently a novel mechanism, by which some genetically deregu...

How to do it: the difficult thyroid

There is a paucity of publications detailing how to deal with the difficult thyroid cancer. When compared to other cancers, it is relatively rare with several histopathological subtypes which run differing cli...

Photodynamic therapy vs. photochemical internalization: the surgical margin

Controlling tumour margins in head and neck surgery is of the utmost importance in preventing loco-regional spread and distant metastasis, which will ultimately lead to a significant reduction in morbidity and...

English law for the surgeon II: Clinical negligence

Traditionally, in the United Kingdom and Europe, the surgeon was generally not troubled by litigation from patients presenting as elective as well as emergency cases, but this aspect of custom has changed. Lit...

The submental flap for oral cavity reconstruction: Extended indications and technical refinements

The submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. However, its role in composite defects involving the jaw is not clearly d...

Myxolipoma in the tongue - A clinical case report and review of the literature

In this article, we present our experience with a case of myxolipoma of the tongue.

Photodynamic therapy and end-stage tongue base cancer: short communication

We previously reported on the outcome of 21 patients with stage IV advanced and/or recurrent tongue base carcinoma subjected to mTHPC-PDT. We continue to develop on the previous work by treating more patients ...

Concurrent radiotherapy and chemotherapy for locally advanced squamous cell carcinoma of the head and neck

Concurrent chemoradiation is the standard treatment for patients with advanced head and neck squamous cell carcinoma (HNSCC).

Head & Neck Oncology

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Head and Neck Cancer: Latest Research

ON THIS PAGE: You will read about the scientific research being done to learn more about head and neck cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about head and neck cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

New medications. Many studies are underway to learn more about new types of drugs that may help treat head and neck cancer.

Immunotherapy. An active area of immunotherapy research is focused on drugs that block a protein called PD-1. PD-1 is found on the surface of T cells, which are a type of white blood cell that helps the body’s immune system fight disease. Because PD-1 keeps the immune system from destroying cancer cells, stopping PD-1 from working allows the immune system to better eliminate the disease. There are 2 immunotherapy drugs approved for the treatment of metastatic or recurrent head and neck cancers (see Types of Treatment ). Researchers are studying PD-1 immunotherapy for people with recurrent and metastatic head and neck cancer in clinical trials.

Combined therapies. Most research for head and neck cancer focuses on combining different types of treatments to improve treatment effectiveness and the patient’s quality of life.

Radiofrequency thermal ablation (RFA). RFA is a minimally invasive treatment option that applies heat to the tumor to destroy cancer cells. It is usually used to treat a localized tumor that cannot be removed by surgery.

Gene therapy. Gene therapy is a targeted form of treatment that uses biologic gene manipulation to change bits of genetic code in a person’s cells. Although gene therapy is relatively new, it appears to show promise in treating head and neck cancer.

Photodynamic therapy. In photodynamic therapy, a light-sensitive substance is injected into the tumor that stays longer in cancer cells than in healthy cells. A laser is then directed at the tumor to destroy the cancer cells. The long-term effects of photodynamic therapy are still being studied.

Proton therapy. Proton therapy can be added to a treatment plan to reduce the damage done to healthy tissue. This radiation therapy technique may help protect important structures in the head, such as the brain stem and the optic nerves that run to the eyes, when used to treat nasopharyngeal cancer , chordoma, or chondrosarcoma. A chordoma is a rare tumor that usually occurs in the spine or the base of the skull. Chondrosarcoma is a tumor that develops in cartilage. They are both types of bone cancer .

HPV. Researchers continue to investigate the link between HPV and head and neck cancers . These studies are evaluating why HPV raises the risk of the disease and how the virus may affect the outcome of some treatments. Studies are also looking at whether the HPV vaccine that is currently used to prevent cervical, vaginal, vulvar, and anal cancer is effective at preventing some head and neck cancers as well.

Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current head and neck cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in head and neck cancer, explore these related items that take you outside of this guide:

To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases .

Review research, news, and information for people with head and neck by visiting the Cancer.Net Blog .

From the 2022 ASCO Plenary Series, a study discussed how people with advanced nasopharyngeal cancer can be treated with immunotherapy and chemotherapy .

Listen to a podcast from an ASCO expert discussing highlights from the ASCO Annual Meeting in 2022 about 2 studies addressing locally advanced head and neck cancer .

Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance in how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Head and Neck Cancer Guide

Cancer.Net Guide Head and Neck Cancer

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Search for dissertations about: "thesis on head and neck cancer"

Showing result 1 - 5 of 108 swedish dissertations containing the words thesis on head and neck cancer .

1. Head and Neck Cancer : Factors Affecting Tumour Growth

Author : Kaarina Sundelin ; Elisabeth Paulette-Hultcrantz ; Karin Öllinger ; Karin Roberg ; Hans Gustafsson ; Linköpings universitet ; [] Keywords : MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; Head and neck cancer ; Chemoradiotherapy ; Tumour ; Malignant salivary ; Metallothionein ; Neo-angiogenesis ; Metastases ; Cytokine tumour necrosis factor-alpha ; hepatocyte growth factor ; Oncology ; Onkologi ;

Abstract : Head and neck cancer is the fifth most common cancer worldwide with an estimated annual global incidence of over 500 000 cases. These malignant tumours develop in the mucosal linings of the upper respiratory tract or in the salivary glands. The most common sites are in the oral cavity and larynx. READ MORE

2. Radiotherapy for head and neck cancer : costs and benefits of time, dose and volume

Author : Karin Söderström ; Björn Zackrisson ; Werner Dubrowsky ; Umeå universitet ; [] Keywords : MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; radiotherapy ; head and neck cancer ; adjuvant treatment ; accelerated fractionation ; biomedicinsk strålningsvetenskap ; Biomedical Radiation Science ;

Abstract : Background In the treatment of head and neck cancers (HNCs), radiotherapy (RT) has the advantage of organ preservation compared to surgery. However, treatment toxicities associated with RT can affect important functions for everyday life, both in the acute and late stage. READ MORE

3. Radiolabeled acetate PET in oncology imaging : studies on head and neck cancer, prostate cancer and normal distribution

Author : Aijun Sun ; Jens Sörensen ; Silvia Johansson ; Mikael Karlsson ; Katrine Åhlström Riklund ; Ingela Turesson ; Heikki Minn ; Umeå universitet ; [] Keywords : MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; 11C-acetate ; 18F-fluoroacetate ; PET ; head and neck cancer ; staging ; delineating tumor volume ; clearance rate ; perfusion ; RT ; treatment outcome ; benign and malignant lymph node ; prostate cancer ; normal distribution ; Oncology ; Onkologi ; onkologi ; Oncology ;

Abstract : The use of positron emission tomography (PET) for imaging in oncology has grown rapidly in recent years. 2-[18F]-fluorodeoxyglucose (FDG) is the most common tracer of PET, although drawbacks exist. READ MORE

4. Head and Neck Cancer: Studies on microvessel density, radiation response and FDG PET

Author : Eva Brun ; Bröstcancer-genetik ; [] Keywords : MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; positron emission tomography PET ; 2-18 fluoro deoxy glucose FDG ; radiotherapy ; microvessel density ; Head and neck cancer ; therapy response ; Cytology ; oncology ; cancerology ; Cytologi ; onkologi ; cancer ;

Abstract : Treatment options of head and neck squamous cell carcinoma (HNSCC) usually include combinations of radiotherapy and surgery, and in some cases addition of chemotherapy. In locally advanced cases cure rates are low. Current prognostic factors cannot foresee the outcome for the individual patient. READ MORE

5. Life after treatment for head and neck cancer

Author : Brith Granström ; Krister Tano ; Ylva Tiblom Ehrsson ; Göran Laurell ; Thorbjörn Holmlund ; Karin Ahlberg ; Umeå universitet ; [] Keywords : MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; head and neck cancer ; intimate relationships ; return to work ; nutrition ; contact nurse ; Oto-Rhino-Laryngology ; oto-rhino-laryngologi ; Oncology ; onkologi ;

Abstract : Background: Treatment for head and neck cancer (HNC) is often multimodal, including surgery, radiotherapy, and chemotherapy. The anatomic location of HNC and its treatments often affect vital functions such as swallowing and speech, but also physical appearance, leading to a risk for social withdrawal and nutritional difficulties that can affect the patient’s quality of life. READ MORE

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HPV-related head and neck cancer treatment is improving, but prevention is best

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Editor's note: April is Head and Neck Cancer Awareness Month.

By Jessica Saenz

Head and neck cancers are cancers in the mouth, throat, sinuses and salivary glands. Most often, these cancers develop in the squamous cells lining the nose, mouth and throat.

Head and neck cancers have common risk factors, including tobacco and alcohol use, environmental factors, and exposure to human papillomavirus (HPV) . HPV has been linked to cancers that affect the oropharynx, the part of the head and neck that includes the tonsils, the back of the tongue, the soft palate and the side and back wall of the throat.

Katharine Price, M.D. , a Mayo Clinic medical oncologist, says that while head and neck cancer treatment has come a long way, prevention is always better. Here's what she wants you to know:

The HPV vaccine can prevent head and neck cancer.

HPV is the most common sexually transmitted infection, and nearly everyone will be exposed to it at some point in their life, according to the Centers for Disease Control and Prevention (CDC) . Most of the time, the body's immune system will clear the virus, but it lingers in about 10% of the population without causing symptoms.

HPV is thought to cause about 60% to 70% of oropharyngeal cancer, a type of throat cancer . "The virus incorporates into the body, causing cancer 20 or 30 years later," says Dr. Price.

"People with HPV cancer will ask, 'Is this a new infection?' The answer is no. This is something they were exposed to decades ago." Dr. Katharine Price

Because it's so common, it's difficult to prevent HPV exposure, but you can prepare your immune system by getting the HPV vaccine . "We use the HPV vaccine to prevent HPV-associated cancers," says Dr. Price. "These vaccines get your immune system to recognize and fight specific antigens. Antigens are how the immune system recognizes something abnormal or foreign."

For maximum effectiveness, the HPV vaccine should be given before people become sexually active. The CDC recommends vaccination starting as early as 9, but it can be beneficial through age 45 . HPV vaccine is part of routine recommended childhood vaccinations for all boys and girls ages 11 to 23. If you haven't been vaccinated for HPV, ask your healthcare professional if it's right for you.

Head and neck cancer is often curable, but treatment can have lasting side effects.

Head and neck cancers have high cure rates with proper treatment . However, approaches like surgery, radiation and chemotherapy can have lasting side effects , including dry mouth, altered taste and difficulty chewing, swallowing, or speaking.

When head and neck cancers spread to the lymph nodes, the lymph nodes might need to be treated with radiation therapy or removed. This can lead to lymphedema , tissue swelling caused by an accumulation of fluid that's usually drained through the body's lymphatic system. It can also cause fibrosis, which is the stiffening of the neck tissues.

Head and neck cancer is often diagnosed after it has spread to the lymph nodes. "About 80% of the time, it will spread into lymph nodes in the neck, and the cancer grows there," says Dr. Price. Head and neck cancer that has spread to the lymph nodes is typically treated with a combination of surgery, radiation therapy and chemotherapy, she says.

HPV-related head and neck cancer will spread to other parts of the body in up to 20% of people who receive the diagnosis.

"We have to tailor treatment based on the person. If cancer has spread to another organ, we usually rely on systemic therapy — a drug that goes everywhere in the body through the bloodstream," says Dr. Price. Examples of systemic therapy include immunotherapy , which uses the body's immune system to kill cancer cells, chemotherapy and targeted therapies that attack specific molecular pathways in cancer cells.

New treatments and research are giving people with head and neck cancer more options.

Dr. Price says immunotherapy has become more widely available and has helped change and improve how head and neck cancers are treated. "The year 2016 was a big pivot point because that's when the Food and Drug Administration approved immunotherapy — pembrolizumab — for the treatment of advanced head and neck cancer," she says. "What's exciting now in research and development is the next generation of immunotherapy drugs. We're getting more creative in engaging the immune system to fight the cancer."

Cancer vaccines are another exciting area of research, says Dr. Price. Some people with HPV-related head and neck cancer have a higher risk of recurrence. David Routman, M.D. , a Mayo Clinic radiation oncologist, is leading a study investigating the use of an HPV vaccine with or without immunotherapy before surgery to prevent recurrence of throat cancer.

Distinguishing between HPV-negative and HPV-related head and neck cancer has also improved treatment. "They have a different biology, and HPV-related head and neck cancers respond better to treatment. They tend to have a higher cure rate," says Dr. Price. For example, a new approach developed by Mayo Clinic called de-escalated adjuvant radiation therapy (DART) for HPV-related throat cancer can give patients fewer long-term side effects and better outcomes .

HPV vaccine hesitancy may contribute to head and neck cancers in the future.

Dr. Price says people often relate HPV to cervical cancer and might overlook HPV vaccination for boys, but it's important to vaccinate all children. "If we look at cancers caused by HPV, the single greatest group of people who get HPV cancer in any given year are men with HPV-associated head and neck cancer, so we need to vaccinate boys."

"If we look at cancers caused by HPV, the single greatest group of people who get HPV cancer in any given year are men with HPV-associated head and neck cancer, so we need to vaccinate boys." Dr. Katharine Price

Also, people who are married or in monogamous sexual relationships might think the vaccine wouldn't benefit them. Still, Dr. Price says having even one sexual partner doubles the risk of HPV, and life circumstances can change. Divorce or the death of a spouse could mean you might go back into the dating pool and be exposed to HPV again. "You might be exposed the second time in the middle part of your life, which could lead to cancer in your 70s. Protecting yourself makes sense because you don't know what's around the corner. Get vaccinated up to age 45 if you haven't already."

Dr. Price says some parents hesitate to vaccinate their children against HPV because they worry it will lead to sexual activity at a young age, but she reassures parents that this is not the case. "Many studies have looked at children who were vaccinated and others who weren't, and they didn't show any increase in high-risk sexual activity or behavior in those who were vaccinated," she says. "This vaccine can prevent cancers that cause a significant amount of death and suffering."

Watch this "Mayo Clinic Minute" video to hear Dr. Price discuss HPV-related throat cancer and the importance of prevention with the HPV vaccine:

Learn more about  head and neck cancers  and find a  head and neck cancer  clinical trial at Mayo Clinic.

Join the  Head and Neck Cancer Support Group  on Mayo Clinic Connect.

Also, read these articles:

• Mayo Clinic Minute: 3 ways to prevent head and neck cancer
• Protecting yourself against HPV
• Innovative technology to treat head and neck cancers
• Protecting kids from cancer with HPV vaccine
• Dear Mayo Clinic: Defining head and neck cancer
• Less is more: The new approach to treating HPV-related throat cancer

Related Posts

Lisa Hardesty, Ph.D., discusses why people struggle to maintain a healthy lifestyle and offers tips to help you stay motivated.

Dr. James East explains that there can be potentially severe complications if GERD is left untreated, including esophageal cancer.

Richard Vile, Ph.D., is leading research into genetically engineered viruses called oncolytic viruses for cancer treatment at Mayo Clinic.

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Prosthodontic rehabilitation of head and neck cancer patients—Challenges and new developments

Nathalie vosselman.

1 Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Center Groningen, Groningen The Netherlands

Jamie Alberga

Max h. j. witjes, gerry m. raghoebar, harry reintsema, arjan vissink, anke korfage.

Head and neck cancer treatment can severely alter oral function and aesthetics, and reduce quality of life. The role of maxillofacial prosthodontists in multidisciplinary treatment of head and neck cancer patients is essential when it comes to oral rehabilitation and its planning. This role should preferably start on the day of first intake. Maxillofacial prosthodontists should be involved in the care pathway to shape and outline the prosthetic and dental rehabilitation in line with the reconstructive surgical options. With the progress of three‐dimensional technology, the pretreatment insight in overall prognosis and possibilities of surgical and/or prosthetic rehabilitation has tremendously increased. This increased insight has helped to improve quality of cancer care. This expert review addresses the involvement of maxillofacial prosthodontists in treatment planning, highlighting prosthodontic rehabilitation of head and neck cancer patients from start to finish.

1. INTRODUCTION

Head and neck cancer is the fifth most common cancer worldwide (Goon et al.,  2009 ). The course of the disease and its treatment have major effects on psychological well‐being and functioning of the patients (Korfage et al.,  2011 ). The treatment of head and neck cancers consists of different treatment modalities, typically being surgery, radiotherapy, chemotherapy or a combination of these modalities. Besides curing cancer, another important aim is to regain the oral function and aesthetics that got lost or altered due to the treatment.

Effects of primary oncology surgery can impede rehabilitation goals (Pace‐Balzan, Shaw, & Butterworth, 2011 ). These effects include an altered oral anatomy, compromised soft tissue conditions like missing or scarred tissues and bulky flaps, altered muscle attachments and muscle balance, sensitivity disorders, loss of lip competence and trismus, loss of anatomical structures, loss of bony structures and/or teeth, and alterations in facial appearance. Regaining oral function and aesthetics is a challenge because of limitations in the restorative treatment options due to, for example, poor support and lack of space for a prosthesis, impeded resilience of soft tissues, impaired tongue function, and loss of integrity and competence of the velopharyngeal complex (Nayar,  2019 ).

Posterior situated tumours, tumour size, adjuvant radiotherapy and extensive soft palate and tongue resections have been shown to be predictors for deterioration of oral functioning (Bohle et al.,  2005 ; Brown, Rogers, & Lowe,  2006 ; Vissink, Jansma, Spijkervet, Burlage, & Coppes.,  2003 ). Studies that looked into the quality of life of head and neck cancer patients after completion of oncologic treatment reported that regaining oral function, including prosthetic rehabilitation, is of great importance (Kamstra et al.,  2011 ; Rogers,  2010 ; Tang, Rieger, & Wolfaardt.,  2008 ). Therefore, the oncological team is in need of specially trained, experienced dental professionals, preferably maxillofacial prosthodontists, to support the team with planning of the oral rehabilitating head and neck patients. This planning and treatment may include the use of osseo‐integrated intra‐ and extra‐oral implants to retain oral and/or facial prostheses.

As mentioned, to achieve rehabilitation goals, a close and open collaboration between ablative surgeons, reconstructive surgeons, radiation oncologists, maxillofacial prosthodontists and medical engineers is of utmost importance to move towards an optimal rehabilitation of the head and neck cancer patient. The purpose of this expert review is to emphasize the role of the maxillofacial prosthodontist in the treatment planning and oral rehabilitation of head and neck cancer patients as well as to discuss challenges and new developments in the prosthodontic rehabilitation of these patients.

2. PRETREATMENT SCREENING

Multidisciplinary first‐day consultation intents to shorten time between diagnosis and treatment of oral cancer (van Huizen et al.,  2018 ). Maxillofacial prosthodontics should be included in the multidisciplinary first‐day consultation. This first‐day consultation aims to provide a preliminary plan stating the required diagnostic procedures and prosthetic involvement (Figure  1 ) so that treatment can start as soon as and as effective as possible. The involvement of the maxillofacial prosthodontist includes a preradiation dental screening (Spijkervet, Schuurhuis, Stokman, Witjes, & Vissink, 2020 ), and a pretreatment dental and oral rehabilitation screening. During this screening, all available information is gathered with regard to self‐care, oral hygiene, dental situation, mouth opening, location of the suspected or confirmed tumour, presumed need for ablative surgery and/or radiotherapy, estimation of retention and bearing of a future (obturator, dental) prosthesis, and estimation of the pre‐existent level of oral function (Jensen, Vissink, Limesand, & Reyland, 2019 ; Spijkervet, Brennan, Peterson, Witjes, & Vissink, 2019 ). This information is needed to design the best prosthetic treatment plan. This plan should be designed taking the patients’ wishes, the tumour characteristics, extent of acquired resection for clean margins, possible types of reconstruction, need for (chemo)radiation, and dental and/or prosthetic possibilities into account.

Involvement of the maxillofacial prosthodontist in treatment planning and rehabilitation of head and neck cancer patients focused on ablative surgery. chemo, chemotherapy; MD, multidisciplinary; MFP, maxillofacial prosthodontics; Post‐op, postoperative; RT, radiotherapy. *Preferably, implants are placed during ablative tumour surgery. When not feasible, implants can also be placed during follow‐up. For details, see Alberga et al. ( 2020 )

2.1. Preradiation dental screening

In case radiotherapy might become involved, head and neck cancer patients in whom the oral cavity is within the radiation treatment portal are in need of a thorough dental examination. These patients have to complete any required dental treatment before the onset of radiotherapy (Schuurhuis et al.,  2011 ). Preradiation dental screening aims to locate and eliminate oral foci of infection, such as unrestorable caries, periodontal disease with pockets ≥6 mm, periapical problems and (partially) impacted teeth (for details, see Spijkervet et al., 2020 ).

2.2. Pretreatment dental and oral rehabilitation screening

Although at the first‐day consultation the extent of the final oncologic treatment plan is uncertain, at this stage the maxillofacial prosthodontists should already estimate whether patients are in need of a prosthetic rehabilitation simultaneously with reconstructive surgery or after completion of cancer therapy, and what the patients’ desires are. Implementing the results of pretreatment screening into the prosthetic workflow ensures that all information is gathered and all needed care is provided to design a patient specific prosthetic rehabilitation draft plan. In some cases, prosthetic retentive considerations are critical to achieve successful prosthetic rehabilitation. The size of the defect and number of critical remaining teeth that may serve as anchorage for conventional clasp supported removable partial denture framework challenges the maxillofacial prosthodontists to obtain insight into the intended therapeutic isodosis fields in relation to the strategic important teeth. This sometimes results in a well‐considered decision to leave teeth which are considered an oral focus of infection in situ (including a thorough discussion of the risk on development of osteoradionecrosis).

With regard to the future prosthodontic rehabilitation, an early decision whether there is a need to place implants is important. This allows for the preferred prosthodontic rehabilitation of head and neck patients. For example, choices in planning, positioning and amount of endosseous oral implants or oncology zygomatic implants are key factors for retention of the prosthetic construction (Alberga et al., 2020 ; Hackett, El‐Wazani, & Butterworth, 2020 ). Literature emphasizes the importance of an immediate implant procedure as it has been shown that placement of mandibular implants in edentulous patients during ablative surgery results in a higher number of patients with functioning mandibular dentures after completion of oncologic therapy (Korfage et al.,  2011 ; Mizbah et al.,  2013 ; Wetzels et al., 2017 ). Furthermore, an increasing trend is observed to early complete the prosthodontic rehabilitation for which an immediate implant procedure is often a prerequisite (Alberga et al., 2020 ; Chuka et al.,  2017 ). When implants are placed postradiation, the anatomical site where the implants are placed seems to effect implant survival, as the implant survival rate is higher in the mandible than in the maxilla and in grafted bone (Chrcanovic, Albrektsson, & Wennerberg,  2016 ; Nooh, 2013 ). Therefore, implant placement during ablative surgery is preferred, at least in selected cases (for details, see Alberga et al., 2020 ).

When there is a need for per‐operative prosthetics, the maxillofacial prosthodontist has to record the actual intra‐oral situation impression taking, intra‐oral scanning and/or cone beam computer tomography (CBCT) imaging all to capture the intra‐oral pretreatment situation and occlusal plane for fabrication of a surgical obturator, surgical guides and models, or an implant‐supported prosthesis. A huge advantage of working with three‐dimensional (3D) intra‐oral scanning is the ease to combine the data of the intra‐oral situation, like the position of teeth and occlusion, with (CB)CT and magnetic resonance imaging (MRI) data of the surrounding tissues in an augmented model. This 3D virtual model provides more insight into the implications and complexity of surgical and prosthetic rehabilitation. This insight allows the surgical team to analyse the surgical and rehabilitation outcome and plan the treatment (Kraeima et al.,  2020 ; Witjes, Schepers, & Kraeima,  2018 ). Although intra‐oral scan techniques are widely used nowadays, some limitations can occur mostly due to poor intra‐oral access caused by, for example, the tumour, trismus or pain. In those situations, analogue impressions are the only feasible option. The produced plaster model can then in a second stage be digitalized in order to create the 3D virtual model.

When mutilating extra‐oral defects are expected as a result of ablative surgery, extra‐oral dimensions have to be recorded as well as to prepare for future extra‐oral prostheses. Although analogue workflows still meet the quality standards of prosthetic care, digital technology has demonstrated ease and utility in design and construction workflows in prosthodontics (Davis,  2010 ). The prosthodontic documentation can be completed by taking clinical photographs. In this way, skin, prosthetic and facial characteristics are captured and aid with communication between the head and neck team. With all gathered information, a prosthetic draft plan can be worked out in preparation of the necessary input of maxillofacial prosthodontists in choice of rehabilitation treatment.

3. MULTIDISCIPLINARY APPROACH

In the past, prosthodontic rehabilitation in the oncological treatment path was a stand‐alone final procedure after completion of oncological therapy. Nowadays, planning of surgical reconstruction starting with occlusion of teeth also safeguards a proper dental rehabilitation. This approach supports a thorough adjustment of the surgical and prosthetic planning and treatment before the oncologic treatment is started (Seikaly et al.,  2019 ; Witjes et al.,  2018 ). In a reconstruction meeting, the head and neck team can go through the available options of surgical, prosthetic or combined reconstruction. The input of maxillofacial prosthodontists in such a reconstruction meeting guards the feasibility from a prosthetic point of view, guided by a prosthetic draft plan, and includes the eventual need for implant placement. With the introduction of 3D planning and computer‐aided design (CAD) assistance, preoperative virtual augmented models provided by medical engineers at these meetings are a great asset to the surgical team and support shared decision‐making regarding favourable reconstruction option after oncology treatment.

3.1. Virtual planning

Once the final oncological treatment plan is agreed upon, having access to a preoperative virtual surgical planning (VSP) can be of importance for the surgical team (Kraeima et al.,  2020 ). Three‐dimensional planning enables a high accuracy of guided resection surgery and prosthetic‐driven reconstruction planning (Kraeima et al.,  2018 ; Tarsitano et al.,  2017 ). Besides a reliable intended outcome, the concept of backwards planning from occlusion maximizes the chances of completing oral rehabilitation of the patient. A 3D VSP can be very precisely executed, with the use of 3D printed guides creating the possibility of completing a full ablative and reconstructive plan in one surgery (Seikaly et al.,  2019 ; Witjes et al.,  2018 ). However, soft tissues are not very reliably reproduced yet by digital techniques. This is still an uncertain factor to be taken into account when it comes to planning prosthetic treatment. The risk of losing prosthetic retention options due to compromised soft tissues means critically assessing choices such as preservation of a functional dental arch (shortened), planning a fixed or removable prosthesis, and indication of per‐operative insertion of endosseous oral implants or oncology zygomatic implants. Tools to better reproduce soft tissues are in development.

4. REHABILITATION OF MANDIBULAR DEFECTS

Smaller head and neck tumours can require resection of soft tissue only and can surgically be managed by primary closure. To overcome possible absence of vestibule or compromised neutral zone, provision of individualized adapted prostheses is required. With such an approach, oral function might reach a near normal level after ablative surgery and prosthetic rehabilitation (Tang et al.,  2008 ).

Advanced tumours can result in large defects, requiring surgical reconstruction (Vaughan, Bainton, & Martin,  1992 ). The resulting altered anatomy can be unfavourable because of flap positioning and presence of scar tissue. Such unfavourable conditions may impair the ability to speak, masticate and swallow. Loss of sensibility, a shallow or absent buccal vestibule, radiation‐induced hyposalivation and trismus may further compromise oral function. Advanced tumour surgery requiring bone resection may further compromise oral function due to loss of the continuity of the mandible, loss of teeth and severe deformities. Most of all, an impaired mobility of the tongue challenges the fabrication of a functional mandibular resection prosthesis as it compromises stability of this prosthesis during speech and mastication (Petrovic et al.,  2019 ).

Many of the aforementioned problems can, at least in part, be reduced by the use of endosseous oral implants to retain prostheses (Figure  2 ). These implants contribute to stabilization of prostheses and reduce loading of the compromised soft tissues and underlying bone (Schoen, Reintsema, Raghoebar, Vissink, & Roodenburg,  2004 ). In many patients, an almost normal masticatory function can be achieved with a rehabilitation of the reconstructed side with implant‐supported removable partial dental prostheses or implant‐retained mandibular overdentures (Kumar & Srinivasan, 2018 ). Maximization of dental rehabilitation significantly improves oral functioning, oral diet achievements and oral health related quality of life (Kansara et al.,  2019 ; Korfage et al.,  2011 ). Several authors reported that a relatively low percentage of reconstructed patients complete prosthetic rehabilitation (Barber, Butterworth, & Rogers,  2011 ). Causes of not completing the prosthetic treatment after implant placement are vertical discrepancy between the graft and the remaining mandible, which leads to an unfavourable implant–crown ratio, poor quality of soft tissues (hypertrophy often appears after the placement of the abutments) and the type of the prosthesis (fixed or removable; Anne‐Gaelle, Samuel, Julie, Renaud, & Pierre,  2011 ). As implant placement during primary reconstruction shortens the interval between surgery and dental rehabilitation, the number of orally rehabilitated patients will increase (Alberga et al., 2020 ; Urken et al.,  1989 ).

Patient diagnosed with squamous cell carcinoma of the tongue after hemiglossectomy and radial forearm free flap reconstruction. (a) Preoperative image of tumour (b) Intra‐oral view after ablative surgery and postoperative radiotherapy. Bar suprastructure with distal extensions fixed on two endosseous implants (c, d) Implant‐supported prosthesis with patient‐specific design to optimize tongue function during speech and mastication. (e) Orthopantomogram 2 years after reconstructive surgery showing good integration of endosseous implants

5. REHABILITATION OF MAXILLARY DEFECTS

Management of maxillary, midface and skull‐base tumours is challenging and complex when it comes to ablative surgery with a need for oral and facial reconstruction, and oral rehabilitation. Maxillary resections lead to a variety of oronasal defects, with a diversity of approaches for restoring oral functioning. Manifold maxillectomy classification schemes are mentioned in literature, all originating from the Brown classification published in 2000 (Brown, Rogers, McNally, & Boyle,  2000 ). These schemes categorize the range of maxillary defects by location, extension like the vertical and horizontal components, and biomechanical forces, and provide guidelines for surgical and prosthetic rehabilitation choices .

5.1. Restorative decision‐making

When tumour resection causes a minor oronasal fistula and primary closure is not feasible, surgical reconstruction with soft tissue flaps alone can lead to excellent functional and aesthetic results, as long as prosthetic retention of teeth replacement is guaranteed. For larger maxillary defects, the option of prosthetic rehabilitation with an obturator prosthesis is the standard of care in many institutions since decades (Aramany, 2001 ; Desjardins,  1978 ). This approach includes maxillary obturators for defects of the hard palate, pharyngeal obturators for defects of the soft palate and maxillopharyngeal obturators for defects that include both structures. However, the discomfort of wearing, removing and cleaning such a prosthesis, its poor retention in large defects and the frequent need for readjustments often limit the value of this cost‐effective method of restoring speech and mastication (Andrades, Militsakh, Hanasono, Rieger, & Rosenthal,  2011 ).

In case of even larger tumours, the defect size increases and the remaining dentition and supporting palatal bone will be more limited. Due to lack of retention and stability of a prosthesis, the interplay of forces further compromises functional rehabilitation and thereby overall success of treatment (Moreno, Skoracki, Hanna, & Hanasono,  2010 ). Placing endosseous implants in the native bone of the maxilla will allow to improve retention of the obturator prosthesis and thereby increase the success of prosthetic rehabilitation. Patients with implant‐supported obturator prostheses have significantly better masticatory and oral function, and less discomfort during food intake than patients with a conventional obturator (Buurman, Speksnijder, Engelen, & Kessler, 2020 ). Studies which compared prosthetic obturation with reconstruction of a palatomaxillary defect demonstrated that there are some advantages to reconstruct the defects above obturation of these defects, in particular with regard to quality‐of‐life issues such as comfort, convenience and feelings of self‐consciousness (Rogers, Lowe, McNally, Brown, & Vaughan,  2003 ). However, especially in medically compromised and older patients, implant‐supported obturator treatment is a viable alternative to surgical reconstruction after maxillectomy (Buurman et al., 2020 ), although an obturator prosthesis is not obsolete and is still standard care in low‐income and middle‐income countries. With the benefits of digital techniques and surgical reconstruction options, the obturator prosthesis has increasingly gained a temporary function by bridging time to secondary surgical reconstruction of the defect.

New workflows are rising in processing surgical obturators. Several case reports describe production of 3D obturator prostheses (Bartellas, Tibbo, Angel, Rideout, & Gillis,  2018 ; Rodney & Chicchon,  2017 ). Three‐dimensional knowledge of resection planes provides a better knowledge of the dimensions of the postresection defect, giving the option of preoperative production of a surgical obturator. With proper tumour visualization and insight in the remaining anatomic structures, a surgical obturator prosthesis can be digitally designed and printed prior to ablative surgery. A nearby fit can be achieved, and only minor per‐operative adjustments are needed (Figure  3 ).

Patient diagnosed with mucoepidermoid carcinoma of the maxilla with prosthetic rehabilitation using a three dimensional printed obturator prosthesis based on a three dimensional virtual surgical planning workflow. (a) Tumour visualization based on CT and magnetic resonance imaging data fusion related to position of digitalized conventional prosthesis. (b) Virtual design of surgical obturator. (c) Image showing preoperative printed surgical obturator. (d) Digital designed and printed obturator prosthesis with nearby fit during ablative surgery

If the defect overextends in size and vertical dimension, obturation of the defect cannot be adequately addressed with prosthetic management alone (Urken et al.,  2018 ). Surgical reconstruction combined with dental rehabilitation is then preferred. Zygomatic implants can, for example, provide a predictable in‐defect support for prosthetic rehabilitation of the maxilla if placed at the time of primary surgery (Butterworth,  2019 ). The zygomatic implant perforated flap procedure combines autogenous soft tissue reconstruction with zygomatic implant‐supported fixed dental rehabilitation (Butterworth & Rogers,  2017 ; Hackett et al., 2020 ). Furthermore, using the Rohner technique in combination with VSP it is possible to reconstruct high level maxillectomy cases with a reliable single‐stage approach (Figure  4 ) in a secondary stage procedure (Rohner et al.,  2002 ; Runyan et al.,  2016 ; Schepers et al.,  2013 ; Seikaly et al.,  2019 ).

Jaw reconstruction of patient diagnosed with ameloblastoma treated with maxillectomy and reconstruction with fibular free flap. (a) The tumour was delineated on the magnetic resonance imaging using radiotherapeutic planning software. (b) Three dimensional virtual surgical planning for tumour ablation surgery. (c) Virtual surgical planning of the maxilla and orbital floor reconstruction with fibula bone and implant planning. (d) Suprastructure fixed on 2 endosseous implants placed in the fibula bone segment. (e) Orthopantomogram 4 years after reconstructive surgery showing good integration of fibula bone segment and implants

6. CONCLUSION

Oral rehabilitation is an encompassing component of the treatment of head and neck cancer patients and is a major contributor to enhance the quality of life of cancer survivors. Involvement in a multidisciplinary team to prepare and execute the rehabilitation treatment is of utmost importance. Maxillofacial prosthodontists should be involved from the beginning, and their role in this process is essential and guiding. The rise of 3D techniques in diagnostics, planning and oral rehabilitation is enormous, and is expected to evolve to the standard of care.

ACKNOWLEDGEMENTS

We would like to thank our colleagues H.H. Glas, MSc, B.J. Merema, BSc, and J Kraeima, PhD for their contribution.

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