Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Eur J Surg Oncol. 2019 Jan;45(1):40-45. doi: 10.1016/j.ejso.2018.02.007. Epub 2018 Feb 14.
Head and neck cancer (HNC) is a rare disease that can affect different sites and is characterized by variable incidence and 5-year survival rates across Europe. Multiple factors need to be considered when choosing the most appropriate treatment for HNC patients, such as age, comorbidities, social issues, and especially whether to prefer surgery or radiation-based protocols. Given the complexity of this scenario, the creation of a highly specialized multidisciplinary team is recommended to guarantee the best oncological outcome and prevent or adequately treat any adverse effect. Data from literature suggest that the multidisciplinary team-based approach is beneficial for HNC patients and lead to improved survival rates. This result is likely due to improved diagnostic and staging accuracy, a more efficacious therapeutic approach and enhanced communication across disciplines. Despite the benefit of MTD, it must be noted that this approach requires considerable time, effort and financial resources and is usually more frequent in highly organized and high-volume centers. Literature data on clinical research suggest that patients treated in high-accrual centers report better treatment outcomes compared to patients treated in low-volume centers, where a lower radiotherapy-compliance and worst overall survival have been reported. There is general agreement that treatment of rare cancers such as HNC should be concentrated in high volume, specialized and multidisciplinary centers. In order to achieve this goal, the creation of international collaboration network is fundamental. The European Reference Networks for example aim to create an international virtual advisory board, whose objectives are the exchange of expertise, training, clinical collaboration and the reduction of disparities and enhancement of rationalize migration across Europe. The purpose of our work is to review all aspects and challenges in and outside this network setting planned for the management of HNC patients.
头颈部癌症（HNC）是一种罕见疾病，可以影响不同部位，其发病率和 5 年生存率在欧洲各地存在差异。选择最适合 HNC 患者的治疗方法时需要考虑多种因素，例如年龄、合并症、社会问题，特别是是否更倾向于手术或基于放射的方案。鉴于这种情况的复杂性，建议创建一个高度专业化的多学科团队，以保证最佳的肿瘤学结果，并预防或充分治疗任何不良反应。文献中的数据表明，基于多学科团队的方法对 HNC 患者有益，并导致生存率提高。这一结果可能归因于提高了诊断和分期的准确性、更有效的治疗方法以及不同学科之间的沟通增强。尽管 MTD 有好处，但必须指出，这种方法需要大量的时间、精力和财务资源，并且通常在组织良好和高容量的中心更为频繁。临床研究的文献数据表明，在高入组中心治疗的患者比在低容量中心治疗的患者报告的治疗结果更好，低容量中心报告的放射治疗顺应性较差，总体生存率较差。人们普遍认为，HNC 等罕见癌症的治疗应集中在高容量、专业化和多学科中心。为了实现这一目标，创建国际合作网络至关重要。例如，欧洲参考网络旨在创建一个国际虚拟咨询委员会，其目标是交流专业知识、培训、临床合作，减少差异，并在欧洲范围内促进合理化移民。我们工作的目的是审查该网络内外计划用于 HNC 患者管理的各个方面和挑战。
