[Ten years of advances in head and neck surgery, how does this influence postoperative radiotherapy?]

Abstract:

:Minimal invasive surgery and reconstructive surgery tend to become the standard in France in the management of head and neck tumors. The use of endoscopic approaches (through endoscopic endonasal/transoral approaches±robot-assisted) instead of open surgery and the use of reconstructive surgery using autologous (flaps) or heterologous materials aim to reduce surgical morbidity by making-up for the loss of substance to restore the function. The impact of these substantial changes in surgical techniques has not been assessed with respect to postoperative radiotherapy practice. Endoscopic endonasal approaches result, however, in piecemeal resection, which, along the analysis of resection margins (a key prognostic factor), make the interpretation of the quality of resection more complex for radiation oncologists. The definition of tumour sub-volumes to be irradiated and doses to these sub-volumes then requires accurate histosurgical mapping and close multidisciplinary consultation between surgeons, pathologists, radiologists and radiation oncologists. Similarly, the increasing use of various types of flaps (of soft tissue or bone flaps), adapted to the patient and tumor anatomy, is associated with substantial modifications to the operating bed. The delineation of tumour volumes in postoperative radiotherapy is made more complex. Tremendous multidisciplinary efforts should now be initiated to fully take advantage of surgical advances and to further optimize the therapeutic index by making radiotherapy also less toxic, i.e. "mini-morbid".

journal_name

Bull Cancer

journal_title

Bulletin du cancer

authors

Thariat J,Leleu T,Micault E,Gery B,Bastit V,Jeanne C,Humbert M,Dugas A,Le Guevelou J,Florescu C,Patron V,Lasne-Cardon A,Babin E

doi

10.1016/j.bulcan.2020.04.011

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

823-829

issue

7-8

eissn

0007-4551

issn

1769-6917

pii

S0007-4551(20)30228-9

journal_volume

107

pub_type

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