title: Treatment choice for locally advanced head and neck cancers on the basis of risk factors: biological risk factors.
abstract: Patients with locally advanced head and neck squamous cell carcinoma often experience relapse, the cause of poor survival statistics. Relapse occurs following the three main types of treatment, surgery with or without post-operative (chemo)radiotherapy, or chemoradiation (containing cisplatin). Cancer relapse can result from (i) outgrowth of residual tumour cells, sometimes with a number too small to be detected by routine histopathology or (ii) development of another carcinoma in a field of pre-neoplastic cells that has remained after treatment of the primary carcinoma. At this moment, clinical staging is not enough to identify patients who will develop relapse and who need tailored treatment. This review describes the latest knowledge of mechanisms of cancer relapse, addresses the biomarkers of potential interest detectable in the tissue of the tumour or its surgical margins and discusses three biomarkers, human papillomavirus, TP53 and epidermal growth receptor in more detail. Once a marker panel has been established, treatment should be focussed on the patients at risk of relapse by improved tailoring of existing treatment modalities. Also, the implementation of more targeting therapies based on the characteristics of the discovered markers should lead to better survival rates.
authors.affiliation: Department of Otolaryngology/Head-Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. bjm.braakhuis@vumc.nl
authors.forename: B J M
authors.initials: BJ
authors.lastname: Braakhuis
authors.forename: R H
authors.initials: RH
authors.lastname: Brakenhoff
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
mesh_terms: D052685:Alphapapillomavirus / Q000472:pathogenicity; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000821:virology; D002471:Cell Transformation, Neoplastic / Q000235:genetics; D002945:Cisplatin / Q000627:therapeutic use; D066246:ErbB Receptors / Q000235:genetics / Q000378:metabolism; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000821:virology; D006801:Humans; D009062:Mouth Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000821:virology; D009367:Neoplasm Staging; D030361:Papillomavirus Infections / Q000473:pathology / Q000821:virology; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D016159:Tumor Suppressor Protein p53 / Q000235:genetics / Q000378:metabolism
chemical_list: C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53; D066246:ErbB Receptors; D002945:Cisplatin