Diagnostic imaging plays an important role in accurate staging, restaging, and treatment monitoring, and is essential in both planning adequate treatment and minimizing treatment-related toxicity and functional impairment in head and neck squamous cell carcinoma (HNSCC). MRI and CT remains the primary imaging modalities for the assessment of HNSCC, but F-18 FDG PET/CT had emerged as a vital adjunct when used in the appropriate clinical setting, such as: delineation of extent of regional lymph node involvement, detection of distant metastasis, identification of an unknown primary tumor, detection of an occasional synchronous primary tumor, monitoring of the treatment response, and long-term surveillance for recurrence and metastases. In this manuscript, clinical application of F-18 FDG PET/CT on HNSCC in initial staging, radiotherapy planning, carcinoma of unknown primary of squamous cell origin, evaluation of response to radiation and/or chemoradiation therapy, and prediction of prognosis will be discussed and other promising PET radiotracers will be introduced.
Carcinoma, Squamous Cell* ; Diagnostic Imaging ; Head* ; Lymph Nodes ; Magnetic Resonance Imaging ; Neck* ; Neoplasm Metastasis ; Neoplasms, Unknown Primary ; Positron-Emission Tomography and Computed Tomography* ; Prognosis ; Radiotherapy ; Recurrence

Basic requirements of head and neck reconstructions are thin resurfacing, a long vascular pedicle, 3-dimensional and well customized reconstruction with a team approach. Ideal reconstruction methods were thought to be free tissue transfer including radial forearm flap, latissmus dorsi or rectus abdominis myocutaneous flap. But recently, there has been concerns about sacrifice of donor structures in these conventional flaps. For minimal sacrifice of donor structures, there has been much evolution in flap concepts, which lead to the introduction of perforator flaps. They are popular in every region for reconstruction. Anterolatral thigh, latissmus dorsi or deep inferior epigastric artery perforator flaps are commonly used. Perforator flaps could also be applied to head and neck reconstructions, because they could be used for the controlled resurfacing of scalp, cheek, neck, oropharynx, and for customized 3-dimensional reconstructions, including diverse components according to each perforator, which may result in more comfortable handling and less restricted access to the defect. The perforator flaps also have long vascular pedicles compared to conventional myocutaneous flaps, which can lead to less restriction in choosing recipient vessels. Perforator flaps have known to have many advantages as described and they give one more option in head and neck reconstruction.
Cheek ; Epigastric Arteries ; Forearm ; Head* ; Humans ; Methods ; Myocutaneous Flap ; Neck* ; Oropharynx ; Perforator Flap* ; Rectus Abdominis ; Scalp ; Thigh ; Tissue Donors

Elective neck dissection for the clinically node-negative neck is targeted to diagnose and eradicate the occult lymph node metastasis. However, this elective neck dissection gives unnecessary risk of complication and morbidity. Therefore, the extent of the elective neck dissection tends to be reduced to minimize the postoperative morbidity. The sentinel lymph node biopsy has been developed for this purpose. Sentinel lymph node is the first lymph node that gets lymphatic drainage from the tumor. Evaluation of this sentinel lymph node enables the prediction of the presence of occult lymph node metastasis. If the biopsy of the sentinel lymph node shows no metastasis, additional neck dissection can be avoided, which reduces the postoperative morbidity. There have been clinical studies on the sentinel lymph node biopsy for the head and neck squamous cell carcinoma, in which the diagnostic accuracy has been reported to be 95-100%. We started sentinel lymph node biopsy for the clinically node-negative, early-staged oral cavity cancer in December 2002. From 2002 to 2004, we evaluated its diagnostic accuracy. The positive predictive value and the negative predictive value were 100% and 98.5%, respectively. We currently determine the elective neck dissection according to the result of the sentinel lymph node biopsy.
Biopsy ; Carcinoma, Squamous Cell ; Drainage ; Head ; Lymph Nodes ; Mouth* ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Sentinel Lymph Node Biopsy*

Sinonasal cancers account for less than 1% of all malignancies and comprise 3% of all head and neck malignancies. The most common malignant neoplasm in the sinuses and nose is squamous cell carcinoma, which accounts for 70% of these neoplasms. Most of these arise in the maxillary antrum, and only 10% to 30% occur in the nasal cavity or ethmoid sinus. It is well known the surgery is primary treatment for sinonasal malignancies. Adjunctive irradiation and/or chemoradiatioin has resulted in improved locoregional control and increased survival rates. The goal of surgical resection is to remove the cancer en bloc, with clear margin devoid of neoplastic cells. For maxillary sinus neoplasms, maxillectomy is a standard surgical procedure. Neoplasms involving the ethmoid, frontal, or sphenoid sinuses may require a craniofacial approach because of frequent invasion into the skull base. The proximity of the nasal cavity and paranasal sinuses to the adjacent structures including the orbit, dura, brain, cranial nerves, and carotid arteries mandates careful radiologic and neurologic evaluations throughout the course of the disease. Surgical advances now permit complex tumor removal and reconstruction surrounding these structures resulting in functional and cosmetic improvements when compared to earlier techniques.
Brain ; Carcinoma, Squamous Cell ; Carotid Arteries ; Cranial Nerves ; Ethmoid Sinus ; Head ; Maxillary Sinus ; Maxillary Sinus Neoplasms ; Methods ; Nasal Cavity ; Neck ; Nose ; Orbit ; Paranasal Sinuses ; Skull Base ; Sphenoid Sinus ; Survival Rate

The objectives of treating oropharyngeal cancer are complete removal of tumor, restoration of function and aesthetics, and such treatments require adequate exposure for direct visual and bimanual examination. It presents challenges for the head and neck oncologist. A thorough evaluation is necessary to stage these tumors appropriately. Surgical treatment requires addressing the primary tumor and also neck disease, reconstructive techniques, and associated morbidities. A multidisciplinary approach helps balance the tumor stage, patient's comorbidities, functional outcome, and patient's wishes, thereby maximizing patient outcomes.
Comorbidity ; Esthetics ; Head ; Humans ; Neck ; Oropharyngeal Neoplasms*

Hypopharyngeal carcinoma is a very aggressive cancer that is generally diagnosed at advanced stages and consequently has a poor prognosis and low survival rate. The treatment of these tumors is designed to cure the patient with the cancer and to preserve or restore physiologic function of the laryngo-pharyngeal complex as well. However, the need for extensive ablative surgery often coupled with radiation therapy renders many patients incapable of performing the basic human functions of swallowing and speech. Loss of such integral functions has a dramatically negative influence on the patients' quality of life, which has already been threatened by the aggressive nature of this disease. Therefore, it is imperative to use a reliable surgical strategy with low morbidity that will allow expedient restoration of speech and swallowing. Consequently, conservation surgery for hypopharynx carcinoma offers a wider resection with promising functional results in hypopharyngeal cancer patients. Recently several procedures were introduced for this purpose and we review the introduction and indications of those conservation methods in hypopharyngeal cancer surgery.
Deglutition ; Humans ; Hypopharyngeal Neoplasms* ; Hypopharynx ; Methods ; Prognosis ; Quality of Life ; Survival Rate

Oral cancer is the sixth most common cancer worldwide. Treatment is directed at the elimination of the primary tumor and neck metastasis with minimal morbidity to the patients. Surgery is the most well established mode of initial definitive treatment for a majority of oral cancer. In spite of a significant paradigm shift in the treatment of many head and neck cancer toward using primary chemoradiation, this treatment is not frequently applied to the oral cavity. Small oral cancers are usually managed by surgery alone. Advanced oral cancers are usually treated with primary surgery followed by radiation. Primary site, location, size, proximity to bone, and depth of invasion are factors which influence a particular surgical approach.
Carcinoma, Squamous Cell ; Head and Neck Neoplasms ; Humans ; Mouth ; Mouth Neoplasms* ; Neck ; Neoplasm Metastasis

The quality of life after surgery for laryngeal cancer may be as important as complete resection of the tumor. Transoral CO2 laser partial laryngectomy for the management of early laryngeal cancer has advangtages with regard to oncological results, preservation of laryngeal functions, complications and cost in comparison to those of open surgery or radiation therapy (RT). Moreover, transoral laser surgery could be a good choice as a salvage surgery in RT-failured early laryngeal cancer. Accumulation of more clinical experiences may lead to consensus for laser surgery as an alternative surgical method to open conserative laryngeal surgery, as it has been with the shift from total laryngectomy to conservative laryngectomy.
Consensus ; Laryngeal Neoplasms* ; Laryngectomy ; Laser Therapy* ; Lasers, Gas ; Quality of Life

Until the early 1990s, the standard treatment for locally advanced laryngeal cancer was total laryngectomy. During the past 20 years, effort was made to save the larynx by using chemotherapy combined with radiation and there has been significant progression in survival and the preservation of the function of larynx in recent days. Now, the standard treatment option for advanced laryngeal cancer is changing from radical surgery to induction or concurrent chemoradiation and the surgery is mainly reserved for salvage operation. But, the quality of life after CCRT is sometimes unacceptable due to severe side effects and some prefer function preserving surgery. The decision for surgical or nonsurgical options needs to be made according to patient's wishes and quality of life goals from a multidisciplinary approach with medical oncologists, radiation oncologists, and head and neck surgeons. Chemoradiation therapy allows for nonsurgical management, but judicious use is recommended because the surgical salvage for failure is much more complicated.
Drug Therapy ; Head ; Laryngeal Neoplasms* ; Laryngectomy ; Larynx ; Neck ; Organ Preservation ; Quality of Life

The multidisciplinary approach to treat squamous cell carcinoma of the head and neck cancer is evolving and complex. Induction chemotherapy has been used in resectable disease for organ preservation, and has shown similar survival when compared with concurrent chemoradiotherapy. Thus, concurrent cisplatin-based chemoradiotherapy is considered as standard treatment for organ preservation for larynx, hypopharynx, and oropharynx cancers. Given that recent evidence of survival benefits with taxane-containing combination chemotherapy for induction chemotherapy, the concept of induction chemotherapy followed by concurrent chemotherapy is being revised. Also, with advances in molecular biology of cancer, a new molecular targeted agent, epidermal growth factor inhibitor (EGFR) antagonist such as EGFR monoclonal antibody showed promising results in the treatment of patients with both locoregionally advanced and metastatic squamous cell carcinoma of the head and neck cancer. Trials with incorporation of this agent are ongoing. In this article, some recent advances in the treatment of squamous cell carcinoma of the head and neck cancer, in particular the expanding role of chemotherapy in organ preservation will be reviewed.
Carcinoma, Squamous Cell ; Chemoradiotherapy ; Drug Therapy ; Drug Therapy, Combination ; Epidermal Growth Factor ; Head and Neck Neoplasms* ; Head* ; Humans ; Hypopharynx ; Induction Chemotherapy ; Larynx ; Molecular Biology ; Organ Preservation* ; Oropharyngeal Neoplasms