Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy
BackgroundMajor advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfe...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-04-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1379861/full |
| _version_ | 1827288010466525184 |
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| author | Juliette Thariat Juliette Thariat Juliette Thariat Florent Carsuzaa Arnaud Beddok Arnaud Beddok Sophie Deneuve Sophie Deneuve Pierre-Yves Marcy Anna Merlotti Catherine Dejean Bernard Devauchelle |
| author_facet | Juliette Thariat Juliette Thariat Juliette Thariat Florent Carsuzaa Arnaud Beddok Arnaud Beddok Sophie Deneuve Sophie Deneuve Pierre-Yves Marcy Anna Merlotti Catherine Dejean Bernard Devauchelle |
| author_sort | Juliette Thariat |
| collection | DOAJ |
| description | BackgroundMajor advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy.MethodsA systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT.ResultsDespite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap–tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications.ConclusionFlap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning. |
| first_indexed | 2024-04-24T11:22:36Z |
| format | Article |
| id | doaj.art-8c5c9809cb3b4e5db485d7d74e400529 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-24T11:22:36Z |
| publishDate | 2024-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-8c5c9809cb3b4e5db485d7d74e4005292024-04-11T04:35:07ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2024-04-011410.3389/fonc.2024.13798611379861Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapyJuliette Thariat0Juliette Thariat1Juliette Thariat2Florent Carsuzaa3Arnaud Beddok4Arnaud Beddok5Sophie Deneuve6Sophie Deneuve7Pierre-Yves Marcy8Anna Merlotti9Catherine Dejean10Bernard Devauchelle11Department of Radiotherapy, Centre François-Baclesse, Caen, FranceCorpuscular Physics Laboratory, IN2P3, Ensicaen, CNRS UMR 6534, Caen, FranceFaculté de Médecine de Caen, Université de Normandie, Caen, FranceDepartment of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, FranceInstitut Curie, PSL Research University, University Paris Saclay, Inserm LITO, Orsay, FranceGordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United StatesSurgical Oncology Department, Centre Léon Bérard, UNICANCER, Lyon, FranceInserm, U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon Bérard, Lyon, FrancePolyclinics ELSAN Group, Department of Radiodiagnostics and Interventional Imaging, PolyClinics Les Fleurs, Ollioules, France0Radiotherapy Department, S. Croce & Carle Teaching Hospital, Cuneo, Italy1Radioophysics, Centre Lacassagne, Nice, France2Departement of Maxillofacial Surgery, University Hospital of Amiens Picardy, Research Unit, UR7516 CHIMERE, University of Picardy Jules Verne, Institut Faire Faces, Amiens, FranceBackgroundMajor advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy.MethodsA systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT.ResultsDespite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap–tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications.ConclusionFlap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning.https://www.frontiersin.org/articles/10.3389/fonc.2024.1379861/fullhead and neck cancerreconstructive surgery/flapradiotherapydelineationtarget volumesrelapse |
| spellingShingle | Juliette Thariat Juliette Thariat Juliette Thariat Florent Carsuzaa Arnaud Beddok Arnaud Beddok Sophie Deneuve Sophie Deneuve Pierre-Yves Marcy Anna Merlotti Catherine Dejean Bernard Devauchelle Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy Frontiers in Oncology head and neck cancer reconstructive surgery/flap radiotherapy delineation target volumes relapse |
| title | Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy |
| title_full | Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy |
| title_fullStr | Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy |
| title_full_unstemmed | Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy |
| title_short | Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy |
| title_sort | reconstructive flap surgery in head and neck cancer patients an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy |
| topic | head and neck cancer reconstructive surgery/flap radiotherapy delineation target volumes relapse |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1379861/full |
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