d. The role of immunotherapy in the management of head and neck cancer is an area of active investigation. There is currently no role in the curative setting, although trials are underway. Current indications for immunotherapy are for unresectable locoregionally recurrent disease and/or distant metastases with both HPV‐positive and HPV‐negative squamous cell cancers of the head and neck.8 In patients with a history of prior head and neck radiation therapy, which additional tests should be performed prior to surgery?Creatinine.Total cholesterol.EKG.Thyroid‐stimulating hormone (TSH).Answer: d. In patients with a history of prior external beam radiation to the neck, there is a significant risk of hypothyroidism. A TSH should be obtained unless recently performed. If a patient is hypothyroid, this should be corrected prior to surgical intervention because the risk of wound complications is significantly higher in patients who are hypothyroid.
References
1 Ang, K.K., Harris, J., Wheeler, R. et al. (2010). Human papillomavirus and survival of patients with oropharyngeal cancer. N. Engl. J. Med. 363: 24–35.
2 Mehanna, H., Wong, W.L., McConkey, C.C. et al. (2016). PET‐CT surveillance versus neck dissection in advanced head and neck cancer. N. Engl. J. Med. 374: 1444–1454.
3 Noronha, V., Joshi, A., Patil, V.M. et al. (2018). Once‐a‐week versus once‐every‐3‐weeks cisplatin chemoradiation for locally advanced head and neck cancer: a phase III randomized noninferiority trial. J. Clin. Oncol. 36: 1064–1072.
Suggested Reading
1 Amsbaugh, M.J., Yusuf, M., Cash, E. et al. (2016). Distribution of cervical lymph node metastases from squamous cell carcinoma of the oropharynx in the era of risk stratification using human papillomavirus and smoking status. Int. J. Radiat. Oncol. Biol. Phys. 96 (2): 349–353. https://doi.org/10.1016/j.ijrobp.2016.06.2450.
2 Bernier, J., Domenge, C., Ozsahin, M. et al. (2004). Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N. Engl. J. Med. 350: 1945–1952.
3 Bots, W.T., Bosch, S., Zwijnenburg, E.M. et al. (2017). Reirradiation of head and neck cancer: long‐term disease control and toxicity. Head Neck 39: 1122–1130. https://doi.org/10.1002/hed.24733.
4 Cooper, J.S., Pajak, T.F., Forastiere, A.A. et al. (2004). Postoperative concurrent radiotherapy and chemotherapy for high‐risk squamous‐cell carcinoma of the head and neck. N. Engl. J. Med. 350: 1937–1944.
5 Gillison, M.L., Trotti, A.M., Harris, J. et al. (2019). Radiotherapy plus cetuximab or cisplatin in human papillomavirus‐positive oropharyngeal cancer (NRG oncology RTOG 1016): a randomised, multicentre, non‐inferiority trial. Lancet 393 (10166): 40–50.
6 Hay, A., Migliacci, J., Karassawa Zanoni, D. et al. (2018). Haemorrhage following transoral robotic surgery. Clin. Otolaryngol. 43 (2): 638–644.
7 Hinni, M.L., Zarka, M.A., and Hoxworth, J.M. (2013). Margin mapping in transoral surgery for head and neck cancer. Laryngoscope 123 (5): 1190–1198. https://doi.org/10.1002/lary.23900.
8 Kubik, M., Mandal, R., Albergotti, W. et al. (2017). Effect of transcervical arterial ligation on the severity of postoperative hemorrhage after transoral robotic surgery. Head Neck 39 (8): 1510–1515.
9 Lee, J.R., Kim, J.S., Roh, J.L. et al. (2015). Detection of occult primary tumors in patients with cervical metastases of unknown primary tumors: comparison of 18(F) FDG PET/CT with contrast‐enhanced CT or CT/MR imaging‐prospective study. Radiology 274: 764–771.
10 Lewis, J.S., Beadle, B., Bishop, J.A. et al. (2018). Human papillomavirus testing in head and neck carcinomas: guideline from the College of American Pathologists. Arch. Pathol. Lab. Med. 142 (5): 559–597.
11 Lim, Y.C., Koo, B.S., Lee, J.S. et al. (2006). Distributions of cervical lymph node metastases in oropharyngeal carcinoma: therapeutic implications for the N0 neck. Laryngoscope 116: 1148–1152. https://doi.org/10.1097/01.mlg.0000217543.40027.1d.
12 Lydiatt, W.M., Patel, S.G., O'Sullivan, B. et al. (2017). Head and neck cancers – major changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual. CA Cancer J. Clin. 67: 122–137.
13 Mehanna, H., Robinson, M., Hartley, A. et al. (2019). Radiotherapy plus cisplatin or cetuximab in low‐risk human papillomavirus‐positive oropharyngeal cancer (De‐ESCALaTE HPV): an open‐label randomized controlled phase 3 trial. Lancet 393 (10166): 51–60.
14 Mehta, V., Johnson, P., Tassler, A. et al. (2013). A new paradigm for the diagnosis and management of unknown primary tumors of the head and neck: a role for transoral robotic surgery. Laryngoscope 123: 146–151.
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17 Pilouze, P., Peron, J., Poupart, M. et al. (2017). Salvage surgery for oropharyngeal squamous cell carcinoma: a retrospective study from 2005 to 2013. Head Neck 39: 1744–1750.
18 Pollei, T.R., Hinni, M.L., Moore, E.J. et al. (2013). Analysis of post‐operative bleeding and risk factors in transoral surgery of the oropharynx. JAMA Otolaryngol. Head Neck Surg. 139 (11): 1212–1218.
19 Pynnonen, M.A., Gillespie, M.B., Roman, B. et al. (2017). Clinical practice guideline: evaluation of the neck mass in adults. Otolaryngol. Head Neck Surg. 157 (2S): S1–S30.
20 Sinha, P., Karadaghy, O.A., Doering, M.M. et al. (2018). Survival for HPV‐positive oropharyngeal squamous cell carcinoma with surgical versus non‐surgical treatment approach: a systematic review and meta‐analysis. Oral Oncol. 86: 121–131.
21 Szturz, P., Wouters, K., Kiyota, N. et al. (2017). Weekly low‐dose versus three‐weekly high‐dose cisplatin for concurrent chemoradiation in locoregionally advanced non‐nasopharyngeal head and neck cancer: a systematic review and meta‐analysis of aggregate data. Oncologist 22 (9): 1056–1066.
22 White, H., Ford, S., Bush, B. et al. (2013). Salvage surgery for recurrent cancers of the oropharynx comparing TORS with standard open surgical approaches. JAMA Otolaryngol. Head Neck Surg. 139 (8): 773–778.
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