title: Integrated therapeutic approaches in head and neck cancer: the importance of multidisciplinary team management.
abstract: Multidisciplinary team (MDT) is of paramount importance in the approach to patients with head and neck cancer. Its aim is to provide the best diagnostic work-up, tumor staging, and treatment. Furthermore, the prognosis of patients who are managed by MDT is usually better. MDT has a great value in all presentation settings. The role of the pathologist in the team is of utmost importance, in particular with regards to information provided on Human Papilloma Virus (HPV) status, which has a well acknowledged independent prognostic value mainly in oropharyngeal carcinoma. In early stage disease, namely in T1-2 N0 M0 patients, the meetings within the MDT mainly involve surgeons and radiation therapists. Surgery represents the mainstay of treatment, while radiation therapy is a suitable alternative, in particular in patients with advanced age, poor performance status and comorbidities. In locally advanced disease, surgeons, medical oncologists and radiotherapists are the key people, since different approaches have been carried out. In operable patients, adjuvant chemoradiation is indicated when resection margins are involved or close, or in presence of extracapsular nodal spread. Concurrent chemoradiotherapy, preceded or not by induction chemotherapy, is the favourite approach in this setting when surgery is strictly not indicated. In recurrent/metastatic disease chemotherapy and best supportive care are the main options, although local treatments, such as reirradiation and salvage surgery, are also worth considering. The standard chemotherapy treatment has finally evolved after about 30 years, and strong efforts are being pursued to further improve the outcome, mainly with the addition of new drugs.
authors.affiliation: National Tumor Institute of Naples- Head and Neck Medical Oncology Unit, Via Mariano Semmola, Naples.
authors.forename: Francesco
authors.initials: F
authors.lastname: Perri
authors.forename: Paolo
authors.initials: P
authors.lastname: Muto
authors.forename: Corrado
authors.initials: C
authors.lastname: Aversa
authors.forename: Antonio
authors.initials: A
authors.lastname: Daponte
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Della Vittoria
authors.forename: Stefano
authors.initials: S
authors.lastname: Pepe
authors.forename: Francesco
authors.initials: F
authors.lastname: Caponigro
mesh_terms: D003131:Combined Modality Therapy / Q000379:methods; D006257:Head / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D009333:Neck / Q000473:pathology