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Brief communication
Published online: 2022-08-26
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Adjuvant radiotherapy post microvascular reconstructive surgery (MRS) for patients with locally advanced head and neck cancer – when and how?

Bogusław Maciejewski1, Małgorzata Stąpór-Fudzińska2, Daniel Bula3, Adam Maciejewski3, Łukasz Krakowczyk3
DOI: 10.5603/NJO.a2022.0044
Affiliations
  1. Div. Research Programmes, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
  2. Dept. Radiotherapy Planning, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
  3. Oncologic and Reconstructive Surgery Ward, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland

open access

Ahead of print
Short review
Published online: 2022-08-26

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 middle 70-ties H. Buncke carried out pioneering microvascular reconstructive surgery (MRS) as a radical treatment. Since that time the MRS has been world-widely accepted as 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 of 20 year experience of the Institute of Oncology in Gliwice with the MRS (about 2500 patients) Bula has defined local recurrence risk factors. The Dutch studies convincingly documented 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 the IMRT-VMAT technique with 50 Gy given in 1.5–1.6 Gy/fraction has been developed 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 middle 70-ties H. Buncke carried out pioneering microvascular reconstructive surgery (MRS) as a radical treatment. Since that time the MRS has been world-widely accepted as 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 of 20 year experience of the Institute of Oncology in Gliwice with the MRS (about 2500 patients) Bula has defined local recurrence risk factors. The Dutch studies convincingly documented 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 the IMRT-VMAT technique with 50 Gy given in 1.5–1.6 Gy/fraction has been developed 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.

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Keywords

advanced and neck cancer; microvascular reconstructive surgery; criteria for postop; VMAT radiotherapy

About this article
Title

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

Ahead of print

Article type

Brief communication

Published online

2022-08-26

Page views

22

Article views/downloads

11

DOI

10.5603/NJO.a2022.0044

Keywords

advanced and neck cancer
microvascular reconstructive surgery
criteria for postop
VMAT radiotherapy

Authors

Bogusław Maciejewski
Małgorzata Stąpór-Fudzińska
Daniel Bula
Adam Maciejewski
Łukasz Krakowczyk

References (17)
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