MISSION

The Group’s research aims to contribute to better patient management at various stages of head and neck cancer by promoting and validating new treatments and examining individual responses to therapies. Studies focus on area or locally advanced cancers such as salivary gland cancers that are recurrent and or metastatic.

PRACTICE CHANGING RESEARCH

Understanding Head & Neck Squamous Cell Carcinoma (HNSCC): A global perspective

Squamous cell carcinoma (SCC) is the second most common skin cancer, primarily arising from squamous cells in the body’s epidermis and other tissues, making up about 90% of head and neck cancers* (HNSCC). SCC of the HNSCC ranks sixth globally in cancer prevalence with 890,000 new cases and 450,000 deaths in 2018 and is expected to increase by 30% (1.08 million new cases annually) by 2030, according to Global Cancer Observatory (GLOBOCAN). Currently only about half the patients with an HNSCC are still alive five years after their diagnosis. This is in part due to the fact that the majority of these patients consult at a late stage and already have cancer that has spread to their lymph nodes at the time they are diagnosed.

* Head & Neck cancer: Term used to describe a number of different cancers that develop in or around the throat, larynx, nose, sinuses, and mouth.

New hope for laryngeal cancer patients

This trial focused on laryngeal cancer, a subtype of head and neck squamous cell carcinoma originating in the vocal cord-containing part of the throat. Historically, surgery or radiotherapy** often resulted in speech loss, impacting patients’ lives. Chemotherapy*** later allowed patients to avoid mutilating surgery.

EORTC transforms quality of life for early-stage hypopharyngeal SCC patients

The trial compared these different approaches, and evaluated whether using chemotherapy combined with radiotherapy instead of surgery as initial treatments could be beneficial in a group of patients with hypopharyngeal SCC. The hypopharynx is situated at the bottom of the throat, just behind the larynx. It found that larynx-preserving treatment did not jeopardise overall survival in patients with SCC of the head and neck and allowed more than half of the survivors to retain their ability to speak26. This, of course, made a huge difference to their daily lives. The results from this study changed the standard of care and practice for patients with early-stage hypopharyngeal SCC from larynx surgery to larynx-preserving radio-chemotherapy.

**Radiotherapy is a type of local cancer treatment that uses beams of intense energy to kill cancer cells. Radiotherapy damages cells by destroying the genetic material that controls how cells grow and divide. Normal cells such as those lining the inside of the mouth may also be affected by these treatments. This slows down the ability of oral tissue to repair itself and increases risk of side effects during treatment.

***Chemotherapy is a treatment that uses drugs to stop the growth of cancer cells that were not visible at the time of surgery, either by killing the cells or by stopping them from dividing.

26 Lefebvre, J. L. et al. Laryngeal preservation with induction chemotherapy for hypopharyngeal squamous cell carcinoma: 10-year results of EORTC trial 24891. Annals of Oncology 23, 2708–2714 (2012).

STUDY INFORMATION

Advanced HNSCC frequently recurs after tumour surgery, sometimes spreading to new areas (metastases). Previous research had shown that post-surgery radiotherapy** can partially reduce this and combining it with chemotherapy*** may enhance local cancer control.

A game-changing approach: post-operative chemo-radiotherapy for improved patient survival

This clinical trial looked at whether adding chemotherapy to radiotherapy after surgery could improve their survival, when treating patients who were at high risk of their cancer returning. It found that compared with radiotherapy alone, combined post-operative chemo-radiotherapy significantly increased the time patients spent without their disease getting worse (progression-free survival). After five years, this had increased by 11%, and the number of them still alive five years later (overall survival) was increased by 13%27. This was an important improvement for these patients who were at high risk of a further deterioration in their cancer state, and today this combined approach is still the reference treatment for them.

Study Coordinator: Prof Jean-Louis Lefebvre

*Head & Neck cancer: Term used to describe a number of different cancers that develop in or around the throat, larynx, nose, sinuses, and mouth.

**Radiotherapy is a type of local cancer treatment that uses beams of intense energy to kill cancer cells. Radiotherapy damages cells by destroying the genetic material that controls how cells grow and divide. Normal cells such as those lining the inside of the mouth may also be affected by these treatments. This slows down the ability of oral tissue to repair itself and increases risk of side effects during treatment.

***Chemotherapy is a treatment that uses drugs to stop the growth of cancer cells that were not visible at the time of surgery, either by killing the cells or by stopping them from dividing.

27 Bernier, J. et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350, 1945–1952 (2004).

STUDY INFORMATION

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