open access
Adjuvant radiotherapy post microvascular reconstructive surgery (MRS) for patients with locally advanced head and neck cancer – when and how?
, 3, 3, 3, 4
Affiliations- Div. Research Programmes, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Dept. Radiotherapy Planning, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Oncologic and Reconstructive Surgery Ward, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Plastic Surgery Ward, Lower-Silesian Specialistic Hospital, Wroclaw, Poland
open access
Abstract
For many decades palliation (radiotherapy, chemotherapy or symptomatic treatment) was the only therapeutic solution for locally very advanced head and neck cancer. In the mid 70s, H. Buncke carried out pioneering microvascular reconstructive surgery (MRS) as a radical treatment. Since that time, the MRS has been accepted around the world as a successful radical therapy, not only for head and neck (H&N) cancers. A part of the H&N cancers need however post-MRS radiotherapy (RT). Based on the 20 year experience of the Institute of Oncology in Gliwice with MRS (about 2500 patients), D. Bula has defined local recurrence risk factors. Dutch studies convincingly documented the prognostic value of the estimated molecular profiles of the resected margins as additional risk factors. The use of conventional 2.0 Gy/ fraction post-MRS-RT result in a high risk of the inserted reconstructive flap necrosis or rejection. Therefore, a novel IMRT-VMAT technique with 50 Gy given in 1.5–1.6 Gy/fraction has been designed which allows to almost eliminate the flap from the irradiated volume and therefore minimizes recurrence and/or flap rejection to almost zero. The present paper shows objectively selected a cluster of patients being the candidate to post-MRS safe and effective VMAT radiotherapy.
Abstract
For many decades palliation (radiotherapy, chemotherapy or symptomatic treatment) was the only therapeutic solution for locally very advanced head and neck cancer. In the mid 70s, H. Buncke carried out pioneering microvascular reconstructive surgery (MRS) as a radical treatment. Since that time, the MRS has been accepted around the world as a successful radical therapy, not only for head and neck (H&N) cancers. A part of the H&N cancers need however post-MRS radiotherapy (RT). Based on the 20 year experience of the Institute of Oncology in Gliwice with MRS (about 2500 patients), D. Bula has defined local recurrence risk factors. Dutch studies convincingly documented the prognostic value of the estimated molecular profiles of the resected margins as additional risk factors. The use of conventional 2.0 Gy/ fraction post-MRS-RT result in a high risk of the inserted reconstructive flap necrosis or rejection. Therefore, a novel IMRT-VMAT technique with 50 Gy given in 1.5–1.6 Gy/fraction has been designed which allows to almost eliminate the flap from the irradiated volume and therefore minimizes recurrence and/or flap rejection to almost zero. The present paper shows objectively selected a cluster of patients being the candidate to post-MRS safe and effective VMAT radiotherapy.
Keywords
advanced head and neck cancer; microvascular reconstructive surgery; criteria for post-op. VMAT radiotherapy
About this articleTitle
Adjuvant radiotherapy post microvascular reconstructive surgery (MRS) for patients with locally advanced head and neck cancer – when and how?
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Review paper
Pages
303-307
Published online
2022-08-26
Page views
3632
Article views/downloads
208
DOI
Bibliographic record
Nowotwory. Journal of Oncology 2022;72(5):303-307.
Keywords
advanced head and neck cancer
microvascular reconstructive surgery
criteria for post-op. VMAT radiotherapy
Authors
Bogusław Maciejewski
Małgorzata Stąpór-Fudzińska
Daniel Bula
Adam Maciejewski
Łukasz Krakowczyk
Agnieszka Niewczas
References (17)- Brizel DM, Gager JL. Locally advanced squamous carcinoma of the head and neck. in Principles and Practice of Radiation Oncology. ed. VII. Wolters Kluwer 2018: 885–894.
- Merlano M, Vitale V, Rosso R, et al. Treatment of advanced squamous-cell carcinoma of the head and neck with alternating chemotherapy and radiotherapy. N Engl J Med. 1992; 327(16): 1115–1121.
- Taylor GI, Daniel RK. The free flap: composite tissue transfer by vascular anastomosis. Aust N Z J Surg. 1973; 43(1): 1–3.
- Tamai S. History of Microsurgery. Plast Reconstr Surg. 2009; 124: e282–e294.
- Koshima I, Yamamoto H, Hosoda M, et al. Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle. Plast Reconstr Surg. 1993; 92(3): 411–420.
- Parrett BM, Pomahac B, Orgill DP, et al. Prefabricated and prelaminated flaps for head and neck reconstruction. Clin Plast Surg. 2001; 28(2): 261–72, vii.
- Cordeiro PG, Santamaria E. A classification system and algorithm for reconstruction of maxillectomy and midfacial defects. Plast Reconstr Surg. 2000; 105(7): 2331–46; discussion 2347.
- Cordeiro PG, Chen CM. A 15-year review of midface reconstruction after total and subtotal maxillectomy: part I. Algorithm and outcomes. Plast Reconstr Surg. 2012; 129(1): 124–136.
- Brown E, Suh HP, Han HHo, et al. Best New Flaps and Tips for Success in Microsurgery. Plast Reconstr Surg. 2020; 146(6): 796e–807e.
- Santamaria E, Cordeiro P. Reconstruction of maxillectomy and midfacial defects with free tissue transfer. J Surg Oncol. 2006; 94(6): 522–531.
- Hidalgo DA, Disa JJ, Cordeiro PG, et al. A review of 716 consecutive free flaps for oncologic surgical defects: refinement in donor-site selection and technique. Plast Reconstr Surg. 1998; 102(3): 722–32; discussion 733.
- Bula D. Ocena przydatności mikronaczyniowej chirurgii rekonstrukcyjnej w leczeniu miejscowo zaawansowanych nowotworów złośliwych środkowego piętra twarzy. Rozprawa doktorska. NIO-PIB, Oddział w Gliwicach, Gliwice 2021.
- Nees M, Homann N, Discher H, et al. Expression of mutated p53 occurs in tumor-distant epithelia of head and neck cancer patients: a possible molecular basis for the development of multiple tumors. Cancer Res. 1993; 53(18): 4189–4196.
- van Houten VM, Tabor MP, van den Brekel MW, et al. Molecular assays for the diagnosis of minimal residual head-and-neck cancer: methods, reliability, pitfalls, and solutions. Clin Cancer Res. 2000; 6(10): 3803–3816.
- Van Houten VM. Mutated p53 as molecular market for diagnosis of head and neck cancer. In: Van Houten VM. ed. Molecular diagnosis and prognostic value of head and neck cancer in surgical margins. Ponser and Looijnen, Wageningen, Amsterdam 2002: 79–100.
- Graveland AP. Molecular diagnosis of minimal residual head and neck cancer and field cancelation. Legatron Electronic Publ, Rotterdam 2005: 21–54.
- Wang TJC, Wun CHS, Cha KSC. Intensity-Modulated radiation treatment – Techniques and Clinical application. in Principles and Practice of Radiation Oncology. ed. VII. Wolters Kluwer 2018: 260–287.