Tumors of the head and neck area: the role of hadrontherapy- Corriere.it

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In 2020, almost ten thousand Italians received a diagnosis of head and neck cancer. They are different forms of cancer that affect the nose, lips, tongue, inside of the mouth, salivary glands, larynx and pharynx that are often diagnosed late, at an advanced stage, when therapies need to be more invasive and the chances of healing are less. As highlighted in a recent online congress, the treatments available to these patients include hadrontherapy with protons and carbon ions, included in the treatments offered by the National Health Service and available in a few countries in the world, including Italy with the National Center for Oncological hadrontherapy (Cnao) of Pavia, where almost 1200 patients with head and neck neoplasia have been treated to date.

Symptoms, who risks the most

Precisely because of the area of ​​the body in which these tumors develop, they are often easily visible, yet several international surveys have shown that they are little known and the symptoms are underestimated. Ulcerations in the mouth, difficulty in swallowing, sore throat or earache, persistent hoarseness, swelling of the neck: if one or more of these symptoms persist for more than 15-20 days it is good to talk to a doctor – warns Lisa Licitra, scientific director of Cnao -. Without being too alarmed, because they are often simple inflammatory pathologies, but they could also be initial indicators of the presence of a tumor in the head and neck area which unfortunately still today in four out of ten cases is diagnosed at an advanced stage, when it is more difficult to cure. . While, if discovered in time, almost nine out of ten sick people could recover. Last year in Italy 9,900 people (7,300 men and 2,600 women) had to deal with one of these cancers, which in 85 percent of cases was due to smoking. Among the known risk factors there are also the excessive consumption of alcoholic beverages, an incorrect diet (diet poor in vitamins of groups A and B, i.e. fresh fruit and vegetables), poor and incorrect oral hygiene especially in who uses dentures and human papilloma virus (Hpv) infection.


The therapies

Diagnosing a head and neck neoplasm is theoretically simple, as it is often already identifiable with a thorough otolaryngological examination during which endoscopy is performed with a flexible instrument (fiberscope). There are many therapies available today – remembers Licitra -: depending on various factors (the site in which the tumor is located, its extension, aggression, the patient’s general health conditions, the expected aesthetic and functional results) can resort to surgery (conservative if possible), chemotherapy, radiotherapy, drugs with molecular target, immunotherapy that can be used alone, in sequence or in combination with each other. They are used for specialized multidisciplinary teams, able to offer patients the experience and all the skills necessary to treat these neoplasms, and centers in which the various specialists for these tumors make decisions by comparing themselves. Since these are diseases that affect the face and organs that are important and decisive for the quality of life, the aesthetic and psychological impact is not secondary and rehabilitation becomes essential. And precisely with a view to preserving healthy tissues as much as possible, hadrontherapy can make an extra contribution, because it allows you to hit the neoplasm very precisely, by administering high doses of radiation that increase the chances of success of the treatment, saving the surrounding areas and healthy organs as possible. Hadrontherapy is reserved for very selected cases in which conventional radiation treatment is expected to produce acute and especially late toxic effects that with hadrontherapy could be reduced both for their frequency and for their severity – explains Licitra -. It is also indicated in some rare cancers of the cervico-facial area as they are known for their scarce possibility of responding to conventional radiotherapy.

When hadrontherapy indicated

At Cnao in Pavia, one of the six centers in the world (the others are in Germany, Austria, Japan and China) capable of treating tumors located in complex anatomical areas and resistant to traditional radiotherapy with hadrontherapy, over 3,300 had already been treated with hadrontherapy patients of which 1,185 with head and neck tumors. Hadrontherapy represents a complex radiotherapy technology which, due to its dosimetric and radiobiological properties, is indicated, within a combined multidisciplinary strategy, in radioresistant, locally aggressive tumors, in complex anatomical areas – he explains Ester Orlandi, director of the Cnao clinical department and member of the board of directors of the Italian Association of head and neck oncology -. To date, this advanced form of radiotherapy is indicated for a specific group of pathologies: chordomas and chondrosarcomas of the base of the skull and rachis; tumors of the brain stem and spinal cord; sarcomas of the cervico-cephalic, paraspinal, retroperitoneal and pelvic districts; sarcomas of the extremities resistant to traditional radiotherapy (osteosarcoma, chondrosarcoma); intracranial meningiomas in critical sites (close proximity to the optic pathways and the brain stem); orbital and periorbital tumors, sinus tumors, ocular melanoma; adenoid-cystic carcinoma of the salivary glands; solid pediatric tumors; relapses requiring re-treatment in an area that has already undergone radiotherapy. To access the treatment through the NHS – concludes Orlandi – it is possible to apply for a preliminary specialist consultation by sending the patient’s clinical documentation to Cnao, which will be evaluated by our medical team.

June 14, 2021 (change June 14, 2021 | 19:45)

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