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

Squamous cell carcinoma (SCC) is the second most common skin cancer, the first being melanoma. It begins in the squamous cells of the body. These thin, flat cells are found in the tissue that forms the epidermis, or outmost layer of the skin, as well as the lining of hollow organs and of the respiratory and digestive tracts. About 90% of head and neck cancers* are squamous cell carcinomas (SCCs). SCC of the head and neck (HNSCC) is the sixth most common cancer worldwide, with 890,000 new cases and 450,000 deaths in 2018. The incidence of HNSCC continues to rise and is anticipated to increase by 30%, or 1.08 million new cases annually by 2030, according to Global Cancer Observatory (GLOBOCAN)). Currently only about half the patients with an HSNCC 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.

This trial was conducted in patients with laryngeal cancer – a form of SCC of the head and neck where tumour cells arise from the cells lining the inside of the larynx, which is the part of the throat that contains the vocal cords (the voice box). Previously, this type of cancer was treated either with surgery or radiotherapy**, both of which would frequently lead to patients losing their ability to speak, and thus have a significant impact on their quality of life. Later, chemotherapy*** provided an alternative that could allow preservation of the larynx.

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 speak. 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.

STUDY INFORMATION

When HNSCC is at an advanced stage the cancer often comes back, either in the same place or close by, after surgery to remove the tumour. Cancer cells may also break away and form new tumours in other parts of the body (metastases). Additional treatment with radiotherapy** immediately after surgery may reduce or delay this to some extent. Previous research had shown that combining post-operative radiotherapy with chemotherapy*** might help stop the growth of the cancer at its original site (local control). This study looked at whether adding chemotherapy to radiotherapy after surgery when treating patients who were at high risk of their cancer returning could improve their survival. 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%. 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.

**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.

STUDY INFORMATION

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