Treatment

Treatments

At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important.

As part of a research medical center, Siteman Cancer Center and Barnes-Jewish Hospital have access to a wide range of clinical trials to test new therapies as they emerge. Many of our doctors are principal investigators in these trials, which cover medical, surgical, and radiation therapies. Discuss with your physician how your cancer might benefit from clinical trials.

Surgery and Other Procedures

Siteman surgeons offer leading-edge treatments both in tumor removal and reconstruction. In the area of tumor removal, they use minimally invasive techniques such as transoral laser microsurgery and transoral robotic surgery for cancers of the larynx, pharynx and oral cavity. The technique allows them to remove tumors through the mouth without opening the patient’s neck, unless they also need to remove lymph nodes. This form of therapy has markedly reduced side effects and hospital lengths of stay. Quality of life is improved with better speech and swallowing.

The following types of surgery may be done:

Wide local excision: This removes the cancer and some healthy tissue around it to get a clean margin around the tumor.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation with or without chemotherapy to kill any cancer cells that are left in the area where the tumor was removed or that have spread to other parts of the body.

Our approach to finding small primary tumors: Human papillomavirus (HPV) tumors can be only one to three millimeters, below the resolution of PET or anatomic imaging, yet still metastasize to adjacent lymph nodes. Consequently, most patients present with a lump on the neck, an involved lymph node. The lymph node is biopsied and found to have cancer cells but they can’t find the primary.

The technique used by Washington University physicians examines tissue in the tonsils and tongue with a powerful microscope and endoscope, and with the pathologist’s collaboration, they find the tiny primary tumor 90 percent of the time. The technique is used with transoral laser or transoral robotic surgical techniques to remove any suspicious tissue without visible incisions. In collaboration with radiation oncologists, this approach has dramatically reduced the need to do follow-up radiation on the throat, sparing patients from long-term problems from the radiation.

Radiation Therapy

Depending on how advanced the head and neck cancer, it may be treated with surgery or radiation therapy or a combination of both. In some instances, chemotherapy may be added.

IMRT (Intensity modulated radiation therapy): When radiation therapy is needed, patients benefit from Siteman’s experience as a world leader in treating head and neck cancers with IMRT, an advanced form of external beam radiation therapy that allows radiation specialists to shape, or conform, radiation doses to the exact three-dimensional shape of a tumor, making the technology ideal for use on irregularly shaped tumors located in the head and neck. In IMRT, radiation specialists can vary the amount of radiation in each beam targeted at the tumor. They also can turn the radiation on and off during treatments. The precise control and flexibility of IMRT minimizes the amount of radiation going to surrounding healthy tissue and predominantly used for head and neck cancers, including thyroid cancer.

Siteman radiation oncologists have recently been involved in several important clinical trials from national collaborative groups such as the NRG, RTOG, and Alliance.  Clinical trials for HPV-related head and neck cancers are focusing on reducing the radiation dose and volume. Both cooperative group and industry sponsored trials are exploring the role of novel agents in head and neck cancer that improve the immune response against the tumor or exploit tumor specific pathways to obtain higher cure rates. Other trials focus on minimizing the side effects from radiotherapy.

Proton beam therapy is another option for patients. Siteman Cancer Center operates the only Proton Beam Therapy Center in Missouri and the region. It houses the world’s first compact proton beam accelerator. Radiation oncologists and physicists here helped evaluate the system and developed the patient protocols and quality standards for this advanced technology.

Proton beam therapy’s main advantage is that radiation specialists can control radiation beams by depth, shape and the amount of radiation given. In other external radiation therapies, radiation beams pass through a patient to a defined location and then exit the body on the other side, leaving deposits of radiation all along their path. Because proton therapy allows for depth control, the majority of radiation is held until the beam hits the precise area targeted, and little to no radiation is delivered past the tumor. This treatment is ideal for patients with solid tumors that are located near sensitive structures or tissues. Proton therapy can be used as a solo treatment option or it can be used in combination with other radiation therapies or chemotherapy. Siteman radiation oncologists mainly use protons for retreatment situations involving one side of the neck.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy is normally delivered into the body by a needle in a vein through a port.

Over the past years, clinical trials have shown that adding chemotherapy or epidermal grown factor receptor (EGFR) inhibitors to standard radiation therapy benefits patients with locally or regionally advanced cancers that line the passages of the respiratory tract.

Members of the head and neck team are continually involved in clinical trials to test new chemotherapy agents that may be promising.

Targeted Therapy finds and attack specific cancer cells without harming normal cells.

The standard of care for the treatment of metastatic and unresectable head and neck tumors is clinical trials. Siteman Cancer Center has the largest number of head and neck clinical trials available in the Midwest. Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient. New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other places may have access to them.