Head and Neck Cancer: Advances Help Personalize Care

The era of caring for every head and neck cancer patient identically is coming to a close. Thanks to recent advances using new medications, unique surgical innovations and lower doses of radiation therapy ― a result of research impacted by physicians at Baptist Health Miami Cancer Institute ― patients are living longer and with an improved quality of life.

April is Oral, Head & Neck Cancer Awareness Month. Approximately 67,000 cases of head and neck cancer are diagnosed in the U.S. each year, according to the National Cancer Institute. Particularly alarming is the rise in numbers of younger patients with oral cancers. In the past, most head and neck cancers were found in patients who smoked, but the recent increase, doctors say, is due to the proliferation of the human papillomavirus (HPV).

Lowering your risk

Anyone can get head and neck cancer, but there is increased risk for tobacco and alcohol users and people with HPV. “Today there is one very effective way to prevent many head and neck cancers ― and cervical cancers as well ― and that is the HPV vaccine,” says Noah Kalman, M.D., MBA, a radiation oncologist with Miami Cancer Institute.

HPV is the most common sexually transmitted infection in the U.S., according to the Centers for Disease Control and Prevention. While the body fights off HPV infections, the effect of the virus on certain cells can lead to HPV-related cancers many years later, with some forms of HPV more likely than others to lead to cancer. Vaccination before exposure helps prevent these cancers. The HPV vaccine is recommended for children and young adults ages 9 through 26 and is offered to adults ages 27 through 45.

Noah Kalman, M.D., MBA, radiation oncologist with Baptist Health Miami Cancer Institute

Vaccination is most effective before a person becomes sexually active, but it can still help prevent cancers if received later. Dr. Kalman suggests that everyone discuss their specific need for vaccination with their primary care physician or ob/gyn. In addition, those vaccinated in the early 2000s, when the immunization first became available, may consider vaccination with one of the newer versions, which protects against more types of HPV.

Where do head and neck cancers occur?

Head and neck cancers can appear in tonsils, tongue and throughout the mouth, including the gums, roof of the mouth and cheek. They also occur in the salivary glands, sinuses, the nose, the larynx (or voice box) and the lower throat.

As with most cancers, early detection is key to good outcomes. The most common symptoms include a mass or lump in the neck, difficulty swallowing, hoarseness, blood in the saliva and/or non-healing sores in the throat.

If it’s cancer

The good news is that many head and neck cancers are curable. “There have been significant advances in surgery, radiation therapy and systemic therapy,” says Dr. Kalman. “These include the use of more tumor-killing drugs that were primarily used for other types of cancer in the past, blood-based biomarkers for early detection and new technologies such as single-port robot-assisted systems.”

The single-port system, designed to fit into the small space of the throat, is being used at the Institute for some patients with oropharyngeal cancers. No incision is required, as the equipment goes down through the throat.

Dr. Kalman is studying radiation dose de-escalation, particularly for specific HPV-positive patients. Current radiation protocols were developed years ago, when most head and neck cancers were smoking-related, he says, adding that HPV-linked cancers respond better to treatment relative to other types of head and neck cancers.

“We are remaking the standard of care and our research is focusing on whether treatment can succeed with less intense treatment, greatly reducing radiation dosage, for example,” he says. The goal is to de-escalate treatment and maintain excellent disease control, while reducing radiation toxicities.

Side effects and toxicities of radiation therapy can include sensitive skin, sore or dry mouth and throat, loss or change in taste, difficulty swallowing or speaking and fatigue.

Clinical trials

The Institute offers a number of clinical trials for head and neck cancer patients. Among them are:

·      The Preservation of Swallowing in Resected Oral Cavity Squamous Cell Carcinoma: Examining Radiation Volume Effects (PRESERVE): A Randomized Trial. 

·      A Phase II Randomized Study of Proton Versus Photon Beam Radiotherapy in the Treatment of Unilateral Head and Neck Cancer – a study to better determine the healthy tissue-sparing benefits of proton therapy versus photon therapy.

·      Photobiomodulation to Demonstrate Safety and Reduce the Incidence of Oral Mucositis in Adult Head & Neck Cancer Patients – The study is for patients with head and neck cancer receiving radiation therapy with or without concurrent chemotherapy.

·      A Phase II Double-Blind Randomized Trial of Topical Gabapentin in Mucolox™ for the Treatment of Oral Dysesthesia. Opening soon.

·      A Randomized, Double-Blind, Placebo-Controlled Study to Determine the Efficacy and Safety of AAV2-hAQP1 Gene Therapy in Participants with Radiation-Induced Parotid Gland Hypofunction and Xerostomia.

It’s important for patients to seek out cancer programs that offer comprehensive care, Dr. Kalman says. “Not all cancer programs have the ability to bring together these cutting-edge treatments with robust, specialized therapy and rehabilitation programs, as well as much-needed survivorship clinics,” he says.

For example, Miami Cancer Institute has the only board-certified cancer center-based oral medicine specialist in South Florida, and the Survivorship Program includes a full spectrum of services with an emphasis on healing, recovery, wellness and disease prevention.

“Our Brain Fitness Lab helps to restore and prevent chemotherapy-induced cognitive impairment and our exercise program helps patients transition safely to an active life,” Dr. Kalman says. “We offer rehabilitation and pain management, psychosocial services, stress management and resiliency training, nutrition and social work services and support groups and educational programs.”

For more information on head and neck cancer care at Miami Cancer Institute, click here.