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The role of surgery in the palliation of head and neck cancer

Roland, Nicholas J.a; Bradley, Patrick J.b

Current Opinion in Otolaryngology & Head & Neck Surgery: April 2014 - Volume 22 - Issue 2 - p 101–108
doi: 10.1097/MOO.0000000000000031
HEAD AND NECK ONCOLOGY: Edited by Piero Nicolai and Cesare Piazza

Purpose of review: The public demands that ‘all modes of treatment’ should be offered to patients who present with head and neck cancer. Up to 40% of patients present with advanced stage disease, of whom some 10% have metastatic disease and are currently deemed incurable. This review summarizes the current role and philosophy of surgical interventions in the palliation of head and neck cancer.

Recent findings: Patients who present with advanced or recurrent head and neck cancers over the past decade have been offered nonsurgical palliative treatments of radiotherapy with or without chemotherapy, with variable responses. The aims are to achieve tumour shrinkage and gain effective relief of symptoms, such as pain, breathing and swallowing. The use of surgery in the palliation of disease and its symptoms has declined significantly since the 1980s. Within the concept of multidisciplinary clinical working as the ‘gold standard’ for the provision of optimum care for the head and neck patient, the place for surgery should be discussed within the many options available currently.

Summary: Patients who present with advanced, incurable or recurrent head and neck cancer should be made aware of their prognosis and the potential need and benefits of palliative care. The active involvement of patients and their carers, their desires and wishes should be the prime consideration for any interventions. Careful selection of suitable patients can achieve prolonged symptom relief safely and result in an improvement in their quality of living. The ultimate goal should incorporate not only quality of life but quality of dying.

aDepartment of Otorhinolaryngology, Head and Neck Surgery, Aintree University Hospital, Liverpool, Merseyside

bDepartment of Otorhinolaryngology, Head and Neck Surgery, Nottingham University & Nottingham University Hospital, Nottingham, England

Correspondence to Professor Patrick J. Bradley, MBA, FRCS, FRCSLT (Hon), FRACS (Hon), 10 Chartwell Grove, Mapperley Plains, Nottingham NG3 5RD, England. Tel: +44 115 9201611; e-mail: pjbradley@zoo.co.uk

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins