Surgery as a Contemporary Therapeutic Modality for Head and Neck Cancer Southern Ohio Medical Center Grand Rounds May 16, 2008 David E. Schuller, M.D. Vice President, Medical Center Expansion and Outreach Professor, Department of Otolaryngology – Head and Neck Surgery John W. Wolfe Chair in Cancer Research CEO Emeritus, The James Director Emeritus, Comprehensive Cancer Center
61
Embed
Surgery as a Contemporary Therapeutic Modality for Head and Neck Cancer Southern Ohio Medical Center Grand Rounds May 16, 2008 David E. Schuller, M.D.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Surgery as a ContemporaryTherapeutic Modality
for Head and Neck Cancer
Southern Ohio Medical Center Grand Rounds
May 16, 2008
David E. Schuller, M.D.
Vice President, Medical Center Expansion and Outreach
Professor, Department of Otolaryngology –Head and Neck Surgery
John W. Wolfe Chair in Cancer Research CEO Emeritus, The James
Director Emeritus, Comprehensive Cancer Center
Master Plan - 2016
Cancer in Ohio
Cancer is the #1 killer in Ohio10th highest rate in US for cancer deaths for women13th highest rate in US for cancer deaths for men6th highest death rate for breast cancer6th highest death rate for colorectal cancerEvery hour of every day, 7 people in Ohio are diagnosed with cancerEvery hour of every day, 3 people in Ohio die from cancer
Cancer in Ohio
Based on American Cancer Society estimates, medical expenditures for cancer cases diagnosed in Ohio annually exceed $1 billion; furthermore, total annual costs, including lost productivity, exceed $8 billion.
Source: Ohio Cancer Incidence Surveillance System Status Report, 2003, Ohio Department of Health, April 2004
NCI designated “Comprehensive” since 1976One of only 39 comprehensive cancer centers in the USAOnly 1 of 5 cancer centers in nation with special NCI Phase I and Phase II contracts for clinical trials 250 cancer investigators in 15 of the 19 collegesGenerates, on average, more than $100M annually in cancer-relevant research funding
The OSU Cancer Program
James Cancer Hospital and Solove Research Institute
Research teaching hospital training the doctors of tomorrowOnly free-standing cancer hospital in Ohio One of only 10 hospitals exempt from Medicare Prospective Payment System (PPS) Founding member of National Comprehensive Cancer Network (NCCN)
The OSU Cancer Program
Background Information
Therapeutic Options
1. Surgery – locoregional
2. Radiotherapy – locoregional
3. Chemotherapy – Systemic
4. Chemoradiotherapy – locoregional
BackgroundHead and Neck Cancer
Survival Improvement NO
Failure Site*Local/Regional 23%Distant 18%
*Laramore, et al., Int. J. Rad. Onc. Biol. Phys., 23(4), 1992
BackgroundHead and Neck Cancer
Quality of Life ImprovementProbably
Patient ComplianceMajor Challenge (36%)*
*Laramore, et al., Int. J. Rad. Onc. Biol. Phys., 23(4), 1992
Definition of Terms
Phase I Trial - ToxicityRecurrent/metastatic, any type/site
Phase II Trial - ResponseRecurrent/metastatic, type/site specific
Phase III Trial - SurvivalPreviously untreated, controlled, randomized
Research Capabilities
Single Institutions Pilot Studies
Individual Cooperative Group Phase I/II Trials
Multiple Cooperative Groups (HNI) Phase III Trials
Treatment Modalities
Surgery
Radiation Therapy
Chemotherapy
Chemoradiotherapy
. . . Non-specific “bigger is better”
Tx Modalities in New Millennium
Surgery organ preservation/ reconstructive techniques
Result: useful swallowing (with aspiration) and speech
1Stein and Schuller, Laryngoscope, 1989.2Alvi and Myers, et al., Head Neck, 1996.
Surgical Organ FUNCTION Preservation
• Speech and Swallowing– Partial laryngopharyngeal defects – flaps
(MC or free)1, 2
– Total laryngopharyngeal defects – flaps (free)3, 4, 5
Result: useful swallowing (with aspiration) and speech1Urken, et al., Arch Otolaryngol., 1997.2Schuller, et al., Laryngoscope, 1997.3Varvares, et al., Head Neck, 2000.4Jones, et al., Ann Plast Surg., 1996.5Rogers, et al., Head Neck, 2004.
Concerns about Non-Surgical Organ Preservation Therapy
• Larynx VA study sustained survival with organ preservation
• Non-laryngeal sites multiple phase II studies1,2
• Goal?– Organ preservation vs. organ preservation with
improved survival?
• Different biological systems Larynx OC, ORO, HYPO
5 yr. Survival 65-70% 30-35%
• For non-laryngeal sites, is it currently justifiable/ethical to offer non-surgical organ preservation therapy based on phase II data with minimal chance of improving survival?