I think the immediate furture is set to involve the use of personalized medicine and in particular HPV/ molecular testing. This is currently widely conducted in the US/ Canada but does not gernally affect the proposed treatment; the next step is to tailor treatment according to molecular results. Not all HPV+ve or -ve cases the same?!

I personally think we are still far from gene/ stem therapy let alone head transplantation!!!!! 

Nice idea though!

Thanks Dr. Ahmed for your comment. What about exposure of tumor to laser after its injection by nanogolden particles leading to death of cancer cells & what about seperating stem tumor cell to be underwent gene recoding followed by its reimplantation into its original tumor leading to stop of cancer growth? Anyone can share us regarding results of these advance.

Dear Hanzem

Cetuximab has been used in patients with unresectable head and neck or more advanced disease. Molecular targets seem the solution, at least, in a near future. I agree with Dr Ahmed that personalized medicine will be the best way to treat cancer in general. I believe in nanotechnology as a promising therapeutical approach.

With kind regards

Lidia

Thanks much Dr. Lidia for your sharing. Would you give details about your experience in molecular medicine & nanotechnology regarding head & neck cancer.

Best Regards.

Hazem.

Dear Dr. Lidia you said "  I believe in nanotechnology as a promising therapeutical approach". Would you give your experience regarding management of cancer by this new technology. Do you use nanogolden particles?

Immunotheraphy

Dear Dr Hazen

sorry for my late answer. I was out.

I investigated the role of nuclear calcium buffering in the enhancement of X-rays radiosensitization in human squamous carcinoma cell line (paper available in my profile) and right now I started a project applying gold nanorods  coated with cetuximab to the same proposal . My review about some molecular targets that have been investigated to improve radiotherapy was accepted and sooner it will available. Regarding nanotechnology and cancer diagnosis/treatment you can find very interesting papers about this issue .

Cheers

Lidai

Thanks much Dr. Lidai for your interesting share, hoping for you all success in your valuable project.

Best Regards.

Hazem

Thanks much Dr. Jae for your share "immunotherapy". Would you give a detail of the role of immunotherapy in treatment of cancer. 

Head and neck cancer is a complex and daunting area of medicine. The more we know the more we realize that a "cure" for advanced disease is still eluding us. The emergence and re-emergence of Chemo and XRT protocols have distracted us for the last many years to think we have somehow made progress. WE HAVE NOT. In the USA, H/N cancer is THE ONLY CANCER for which survivals have GONE DOWN. This has to mean something. The only variable I can pin this on is our inexorable tendency to see the chance not to operate  is the options to take. In my opinion, the chance not to operate is the chance NOT to cure. To be fair, many cases of advanced H/N cancer need multi modality treatment. Trying to exclude surgery as one of those modalities has sadly produced a legion of patients I refer to as the "undead". They have no meaningful quality of life. They are tracheostomy dependent, have little to no voice, are gastrostomy dependent and live between pneumonias. For this they should thank us? I believe in the preciousness of life but look at these pitiable people and wonder if they don't support the need for physician assisted suicide. Be certain that I don't make such recommendations but think instead that we should learn from these all too common outcomes and do our utmost to avoid this kind of "non-surgical" barbarism. 

On the flip side, trans oral robotic assisted surgery or TORS had added a lot to what was already well founded as trans oral laser microsurgery or TLM. The robot has enabled great advances to H/N cancer surgery. Even those who were not particularly able with the microscope and laser can now bring minimally invasive natural office care to very advanced H/N cancer. It is not yet ready for wide adoption but soon the size of the instruments and the articulation of the telescopes will enable a big jump in who can be offered this care…and who will be able to perform it. 

Stay tuned. There is hope.

pfc

Thanks much Dr. Paul for your valuable summarized comment. You said  "In my opinion, the chance not to operate is the chance NOT to cure." Do you mean operable or non operable cancer.  I think surgical dissection of tumor alone is a symptomatic treatment removing the bulk of tumor & its pressing effect because there is still the pathogenesis even micro invasion or micro metasasis but postop. chemio+/-radiotherapy is somewhat curative.  Sure there is hope so as there is continued research in this field. Are there in your center any new research including genotherapy or stem cell therapy. 

Would all follow this website which discuss cancer management  http://www.telegraph.co.uk/science/science-news/11062255/Lets-stop-trying-to-cure-cancer-says-cancer-professor.html 

Let's stop trying to cure cancer, says cancer professor

Professor Mel Greaves claims that most cancers cannot be cured and experts should look at ways of preventing and managing the disease instead

http://www.telegraph.co.uk/science/science-news/11062255/Lets-stop-trying-to-cure-cancer-says-cancer-professor.html

One could make the case the head and neck cancers (HNCA) in advanced states such as T4 lesions invading vital structures like the carotid or the pre vertebral fascia or the deep muscles of the neck, have such low "cure" numbers as to be considered "incurable". The cure numbers are low but they are not ZERO. There are 5-10% survival numbers for most lesions in the HNCA population to make hard the case for giving up on trying to cure these diseases. The question needs to be "cure at what cost" and by this I decidedly DO NOT MEAN financial. The morbidity of the extreme care scenarios is very high and needs to be taken on with very frank discussions with our patients so that they really know what they are embarking on. My earlier criticism is in the care of the truly curable cancers, typically T1-3. When we abdicate operating on these cancers there are a myriad of possibilities that can make our counting on radiation and chemotherapy truly regrettable. To be sure, there are lesions as "early" as T1 cancers of the hypo pharynx, for example, that can need multi modality care…even tri-modality care of surgery, XRT and chemotherapy. IF IN THESE CASES we have not operated as the primary treatment, we cannot know if one, two or three treatment options are needed. Sometimes in an effort to "avoid surgery at all costs" we over treat disease and leave a patient to suffer the rest of their lives, sometimes many decades, with the unrelenting if not progressive effects of post treatment toxicity such as dysphagia with aspiration, poor of no voice quality and a marginal airway if any at all. This is not an outcome I would accept if I or one of my loved ones would have these diseases. 

This is my penultimate point: if we would neither have nor advocate a family member to have a treatment for a particular disorder, how can we in good conscience EVER recommend it to our patients? This should be a bottom-line minimum criteria for recommending ANY form of treatment for any one and any disease, most of all diseases like HNCA where the consequences of care choices can be so long lasting and so hard to suffer.

Thanks again Dr. Paul for your last recomment. Are there in your center or in USA in general any new research including nanotechnology, genotherapy or stem cell therapy as a new possible future ways of treatment of cancer. If there is, you would distribute the results.

There are. A new Ph.D. colleague did her doctoral research on gold nano rods and Stage IV cancer therapy. It is a very exciting area. I will get her into this discussion.

Thanks Dr. Paul, would you mention the results. Some colleagues in Egypt worked on nanogolden particles injected into cancer tumor followed by exposing the tumor to laser leading to cancer cells damage. But how the body can get rid of this injected gold. 

Photodynamic therapy is a trend to treat this kind of cancer,however, it only  works to superficial tumors. Some research groups are trying to improve chemo and radiotherapy using this approach. I think applying nanotechnology is one of the future subjects of cancer science.

Thanks Dr. Lidia for your sharing. 

Immunotherapy has a place in some head and neck cancer.