Head and neck cancer: an evolving treatment paradigm

Abstract

Since the inception of this journal in 1948, the understanding of etiologic factors that contribute to and the treatment of head and neck cancer has evolved dramatically. Advances in surgery, radiation therapy, and chemotherapy have improved locoregional control, survival, and quality of life. The outcomes of these treatment modalities have shifted the focus of curative efforts from radical ablation to preservation and restoration of function. This evolution has been documented in the pages of Cancer for the past 6 decades. This review focuses on the evolution of treatment approaches for head and neck cancer and future directions while recognizing the historic contributions recorded within this journal.

FIGURE 1

Slaughter et al introduced the concept of ‘field cancerization’ in Cancer in 1953. This material is reproduced with permission of Wiley-Liss, Inc, a subsidiary of John Wiley & Sons, Inc. Cancer. September 1953;6(5):963–968. Copyright 1953 American Cancer Society.

FIGURE 2

Lymph node levels of the neck. A radical neck dissection (RND) includes all lymph node levels I through V as well as the internal jugular vein, the spinal accessory nerve, and the sternocleidomastoid muscle. A modified RND (MRND) includes the same lymph node levels as an RND but spares 1 or more of the nonlymphatic structures. The selective neck dissection preserves 1 or more of the lymph node groups normally included in an MRND. Therapeutic neck dissection refers to treatment for clinically positive disease. Elective neck dissection is for the prophylactic removal of lymph node levels based on the known risk of occult metastases.

FIGURE 3

The radical neck dissection as described by Hayes Martin in 1951. N indicates nerve; M, muscle; V, vein; Int. jug. V., internal jugular vein, Ant., anterior. This material is reproduced with permission of Wiley-Liss, Inc, a subsidiary of John Wiley & Sons, Inc. Cancer. May 1951;4(3):441–499. Copyright 1951 American Cancer Society.

FIGURE 4

The Karnofsky performance status score as introduced in 1948. This material is reproduced with permission of Wiley-Liss, Inc, a subsidiary of John Wiley & Sons, Inc. Cancer. November 1948;1(4):634–656. Copyright 1948 American Cancer Society.