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Head and Neck Cancer Treatment

Head and neck cancers may grow quickly. The earlier that a cancer is diagnosed, the more likely the treatment will be successful.

Louis Portugal, Amanda Ruiz, Jonas de Souza Amanda Ruiz, center, was diagnosed with nasopharyngeal cancer while she was pregnant with her third child. Otolaryngologist Louis de Guzman Portugal, MD, left, and medical oncologist Jonas de Souza, MD, worked together with other UChicago Medicine specialists to ensure Ruiz received effective, safe cancer care that also protected the health of her baby.

At the University of Chicago Comprehensive Cancer Center, our physicians strive to provide head and neck cancer treatment that is effective and gives the patient the best chance of preserving speech, taste, and swallowing function. In most cases, effective treatment does not require radical surgery.

Matching the appropriate treatment to the right patient is vitally important in cancer care. For head and neck cancer, treatment may involve an intensive combination of radiation and chemotherapy. Or it may center on surgery, followed by radiation and chemotherapy. University of Chicago experts from surgery, medical oncology and radiation oncology work together as a team to develop the best treatment plan for each patient.

Head and neck cancer treatment options are determined by the stage of the cancer, the location of the tumor, and other factors. Here, treatment is typically provided as outlined in the following table:

Cancer Stage Treatment

Stage I

Surgery or radiation therapy

Stage II (cancer has not spread to lymph nodes)

Therapy depends upon the location of the tumor, and may include surgery, radiation therapy or chemotherapy, or a combined approach.

Stages III and IV

A combined radiation therapy and chemotherapy approach is typically the first line of treatment. In other cases, surgery is performed first, followed by chemoradiation.

Recurrent and/or Metastatic Disease

In addition to salvage treatment approaches (treatments given after the cancer has not responded to previous treatments), such as surgery and second courses of chemoradiation, we offer many novel therapies as part of clinical trials, including several immunotherapy options.

Chemotherapy Plus Radiation: A "One-Two" Punch

Grant AchatzA combined treatment approach of radiation therapy and chemotherapy saved chef Grant Achatz's tongue from surgery. »Learn more

Doctors at the University of Chicago Comprehensive Cancer Center are leaders in the development of a new treatment regimen that helps certain patients with head and neck cancer avoid surgery. This combined therapy approach harnesses the power of chemotherapy and radiation therapy to work in tandem to shrink tumors. Our experts have published several studies on the success of this approach.

A sample combined therapy approach may involve five, 14-day treatment cycles. For the first five days of the treatment cycle, the patient will receive multiple chemotherapy drugs and twice-daily radiation therapy treatments during a hospital stay. Then, the patient returns home for nine days. Patients who previously had surgery may be treated with four, 14-day cycles of treatment.

Any patient with any type of head and neck cancer with lymph node involvement may be a candidate for this approach.

Precise Radiation Therapy Treatments

Craig Martin Craig Martin is back to serious running after treatment for stage IV tonsil cancer.

At the University of Chicago Comprehensive Cancer Center, our radiation oncologists are internationally recognized for their expertise, and use sophisticated methods and machines to deliver precise treatments that target tumors while sparing healthy tissue. We were one of the first hospitals in the nation to offer intensity modulated radiation therapy (IMRT) to treat head and neck cancer. With IMRT, the radiation beam is accurately shaped to follow the contours of the tumor. The beam's intensity is controlled in relation to its location on the tumor and its proximity to healthy tissues and critical structures such as the salivary glands or the optic nerve.

Our team uses image-guided radiation therapy (IGRT) to ensure that treatments are set up the right way, every time. Before each treatment, our specialists confirm the exact tumor position and make any needed adjustments before treatment begins. Here, our experts have refined IGRT by developing a 3-D imaging system to improve treatment planning. An added benefit of this system is faster treatment sessions since less time is required for set-up at each visit.

When Surgery Is the Solution

For many patients with early-stage head and neck cancer, surgery is the best option for a successful outcome in terms of survival and preservation of function. Endoscopic laser resection is one of the many techniques used to address early stage lesions. This minimally invasive approach uses sophisticated thin instruments equipped with a laser that enables the surgeon to remove tumors with pinpoint precision.

When patients have advanced disease, our expert surgeons work with radiation and medical oncologists to develop the best treatment plan.

Gary Hoffman Gary Hoffman sought help from UChicago Medicine experts to correct a failed jaw reconstruction for oral cancer that was performed at another hospital.

When Reconstruction Is Needed

Our cancer experts are skilled at using organ-sparing and reconstructive techniques to maintain a patient’s physical appearance and function during or after treatment. Patients are often referred to the University of Chicago for complex wounds that have developed as a complication of prior treatment. Examples include soft-tissue wounds, aspiration (inhalation of material into the lungs), and osteoradionecrosis (bone death caused by radiation). Our head and neck surgeons team with our plastic surgeons to transfer new tissue to help heal wounds, relieve pain, and give hope.

Immunotherapy: Boosting the Immune System to Fight Cancer

UChicago Medicine oncologists are pioneers in immunotherapy, treatments that help the immune system -- the body's natural defense system -- fight cancer. Immunotherapy is less likely to cause the side effects associated with traditional cancer treatments such as chemotherapy or radiation therapy. In particular, novel, immune checkpoint inhibitors help the body recognize and attack cancer cells. A 2015 study by our experts found that the anti-PD-1 immunotherapy pembrolizumab was effective in very advanced recurrent/metastatic head and neck cancers and roughly twice as good as the best currently approved targeted therapy. In this study, immunotherapy was active across a wide range of patients, including HPV-associated and HPV-negative tumors. While still an emerging treatment approach for head and neck cancer, our experts offer these treatments as part of clinical trials, as they hold potential to prolong survival for many patients.

A Center of Excellence for HPV-Associated Head and Neck Cancer

In recent years, cases of head and neck cancer linked to the human papillomavirus (HPV) have increased dramatically. HPV is the most common sexually transmitted disease in the United States, and is the cause of most cases of oropharynx cancer (cancer of the tonsils and base of the tongue). These tumors are different from traditional head and neck cancers with respect to risk factors and prognosis.

Our team has many years of experience treating patients with HPV-positive head and neck cancer, and is at the forefront of research into how HPV-associated cancers differ in response to treatments, with the goal of tailoring effective therapies to reduce side effects and improve overall quality of life. Examples of outstanding care include more accurate testing, making treatment less intense and therefore better tolerated, and using new approaches that harness the power of the immune system to fight cancer.

Many Options for Recurrent Disease

For patients with recurrent disease, options often include surgery in addition to radiation, and experimental therapies. Our doctors can provide innovative approaches and state-of-the-art reconstructions for patients with recurrent cancer. Our treatments can provide pain relief, wound rehabilitation and hope for survival. Patients with recurrent head and neck cancers are often referred after being told "nothing can be done." Our team believes that there is always something that can be done to support patients and their families.

The University of Chicago Comprehensive Cancer Center is a leader in re-irradiation--a second treatment with full-dose radiotherapy--combining radiation with chemotherapy and molecularly targeted agents. In addition, we have a very active program using novel drugs in patients with metastatic disease including several immunotherapy options.