Optimizing approaches to head and neck cancer: Strengths and weaknesses in multidisciplinary treatments of locally advanced disease

Head and neck cancer (H&NC) is the fifth most common neoplasm worldwide, the estimated incidence being >500 000 cases diagnosed per year [1]. H&NC is more frequent in men in their 60s and 70s, and some 60% of cases are diagnosed at the locally advanced stage. H&NC remains a significant cause of mortality, with >300 000 deaths yearly [2]. H&NCrepresents a complex group of malignances. There are eight anatomic sites: nasopharynx; nasal cavity and paranasal sinuses; oropharynx; oral cavity; larynx; hypopharynx; salivary glands; and thyroid glands. Most of these sites have several subsites. Their anatomic situation means that treatment can affect vital functions, such as speech or swallowing, that may considerately reduce a patient’s quality of life. Squamous cell carcinoma (SCC) is the most frequent histological type; other tumours are classified as carcinomas (undifferentiated, anaplastic epithelial), adenocarcinomas (adenoid cystic, mucoepidermoid, salivary duct), estesioneuroblastoma or lymphomas. Such anatomic and pathological variability affects diagnosis, tumour biology, prognosis and treatment [3]. Given this complexity, it is not surprising that clinical management is also complicated and requires a concerted effort among multiple specialties.