The first approach to treatment is essential. Cure is the main goal, and is considered as important as the quality of life and functionality of the treated organs, such as the voice, language, swallowing, taste and breathing. IEO provides patients with a multidisciplinary team dedicated to diagnosis, treatment and rehabilitation.
Innovative and minimally invasive therapies: over the years the Division has developed some original techniques and minimally invasive approaches to improve the oncological and functional results of interventions, so that patients have more therapeutic options with less surgical impact. Some of these therapies are available only here in IEO.
Surgery: our head and neck surgeons perform the highest number of operations for malignant tumours each year than any other center in Italy (AGENAS data). Moreover, for more than 20 years we have been conveying the message of Prof Veronesi, that is, "the minimum effective therapy" also for head and neck lesions. We were the first in Italy to offer conservative thyroid surgery, with over 15 years of experience in hemi-thyroidectomy even for malignant tumours. We were among the first to perform endoscopic conservative surgery of the larynx with over 250 procedures a year, we were pioneers in functional tongue surgery allowing a near normal post-op quality of life. Finally, for over 20 years we have been performing very delicate salivary gland surgery. This is the only recognised head and neck surgery department in Italy
Compartmental tongue surgery: a technique devised and developed at IEO in 2000 which has revolutionized the oncological surgery of tongue carcinomas, drastically improving patien' prognosis even in advanced cases.[1]
[1] Calabrese L, Giugliano G, Bruschini R, Ansarin M, Navach V, Grosso E, Gibelli B, Ostuni A, Chiesa F.: Compartmental surgery in tongue tumours: description of a new surgical technique. Acta Otorhinolaryngol Ital. 2009 Oct;29(5):259-64.
Calabrese L1, Bruschini R, Giugliano G, Ostuni A, Maffini F, Massaro MA, Santoro L, Navach V, Preda L, Alterio D, Ansarin M, Chiesa F. Compartmental tongue surgery: Long term oncologic results in the treatment of tongue cancer. Oral Oncol. 2011 Mar;47(3):174-9. doi: 10.1016/j.oraloncology.2010.12.006. Epub 2011 Jan 22
Ansarin M, Bruschini R, Navach V, Giugliano G, Calabrese L, Chiesa F, Medina JE, Kowalski LP, Shah JP. Classification of GLOSSECTOMIES: Proposal for tongue cancer resections. Head Neck. 2019 Mar;41(3):821-827. doi: 10.1002/hed.25466. Epub 2019 Jan 2.
THE VALUE OF A MULTIDISCIPLINARY TEAM
Our multidisciplinary team is dedicated to the diagnosis, treatment and rehabilitation of patients with tumors of the head and neck, and to the study of these diseases. Our team includes over thirty oncology professionals with expertise in various specialties, such as ENT, maxillofacial surgery, emergency surgery, plastic-reconstructive surgery, radiotherapy, medical oncology, radiology, pathology, nuclear medicine, nutrition, physiotherapy, endocrinology, dentistry, voice therapy, speech therapy, psychology, and biology.
The integration of various skills can address complex clinical problems, from diagnosis and treatment planning, to the functional recovery (speech, breathing, swallowing) in order to achieve the best results with cancer and adequate quality of life. The cervicofacial surgery program consists of the medical-surgical team, Radiotherapy and Medical Oncology specialists, dedicated radiologists, endocrinologists, nuclear physicians and pathologists. The team works in harmony and meets on a weekly basis to discuss cases of patients who trust in our structure. They develop comprehensive personalized care plans considering all aspects of treatment and rehabilitation, considering the different treatment options, taking into account the needs of individual patients in accordance with internal, national and international guidelines.
The team, in close collaboration with the Scientific and Health Management Board, monitors the results of treatment and the quality of the performances in real time in order to point out critical issues and identify areas for improvement and development. The multidisciplinary meetings are an opportunity for professional development based on the exchanges in the group, the evidence in the literature, and the critical review and update of guidelines as well as diagnostic and therapeutic approaches. The information obtained from the critical review of the clinical activities, from technological innovations, from the study of the evolution of the cancers treated, and from continuous updating are used to identify open issues and propose research activities. Thanks to this approach, clinical research activities and institutional research projects in collaboration with national and international institutions have been put in place.
Oral cavity cancers
Therapy is primarily surgery. The earlier the diagnosis, the lighter the surgery will be and the milder the consequences on functionality. In more advanced cases, larger removals are necessary, followed by sophisticated reconstructions through autografts, and rehabilitations of variable duration after surgery. Radiotherapy and chemotherapy are only used as complementary to surgery in selected cases, or as curative therapies in cases where surgery cannot be performed or when it is refused by the patient.
At IEO, a new method has been developed for the surgical removal of the oral cavity and oropharynx tumours, called compartmental surgery, which allows an significant improvement in prognosis in over 400 cases of advanced tongue cancer treated.
Distant metastases of head and neck carcinoma
Distant metastases are defined as tumor spread to other organs. Lung, liver, and bone are the most common sites for hematogenous metastases of head and neck squamous cell carcinoma. The incidence of distant metastasis in head and neck squamous cell carcinoma is low for the general head and neck squamous cell carcinoma population: generally below 5% at presentation. Head and neck squamous cell carcinoma patients with distant metastases are generally candidates for palliative treatment scenarios only, because currently no systemic therapy has curative potential in head and neck squamous cell carcinoma patients with distant disease. Consequently, extensive locoregional treatment is usually considered futile in these patients. Particular attention is paid to our collaboration with CNAO, National Centre of Oncology Hadrontherapy) for Phase II, the clinical trial on radiotherapy boost, using protons (hadron therapy) for locally advanced tumours of the cervical-cephalic region.