Head and neck cancer doctors at Perlmutter Cancer Center help people with cancer look better and experience fewer side effects
For people with head and neck cancer, retaining the ability to speak, swallow or smile after treatment is as much a concern as managing the disease. If caught early, head and neck cancer is more responsive to treatments, but treatments can leave people with lingering conditions, such as an inability to speak or swallow and facial paralysis.
The multidisciplinary team at the Head and Neck Center at NYU Langone Health’s Perlmutter Cancer Center continually innovates procedures, treatments, and clinical trials to provide patients with optimal survival with the highest possible quality of life.
“Our team of medical, radiation, and surgical oncologists has been at the forefront of developing effective treatments for patients with head and neck cancers,” says Adam S. Jacobson, MD, associate professor in the Department of Oto -Rhinolaryngology – Head and Neck Surgery at NYU Grossman School of Medicine and Director of the Head and Neck Center. “We offer high level care for all different head and neck cancers, and we offer a unique experience that allows patients to be cared for in a Cancer Center where all our specialists are gathered in one place.”
For people with head and neck cancer, that means they’ll be seen by surgeons, doctors, and radiation oncologists who occupy offices on the same floor of the Head and Neck Center at Perlmutter Cancer Center— 34th Street.
“To my knowledge, there is no other head and neck cancer treatment center in New York City where patients with these cancers are seen in a very coordinated fashion,” says Kenneth S. Hu, MD, professor at Departments of Radiation Oncology and Otorhinolaryngology – Head and Neck Surgery at NYU Grossman School of Medicine. “This is a unique patient-centered treatment approach that patients love because when they come here, their assessment and treatment is vertically and horizontally integrated into one stop.”
In addition to the various experts and specialists who help with diagnosis, treatment, and follow-up imaging, oncologists work closely with rehabilitation specialists from Rusk Rehabilitation at NYU Langone Orthopedic Hospital to help people recover their function and to resume their routines after completing their treatment.
Beyond the care patients may receive in Manhattan, the Head and Neck Cancer team extends care to patients in Brooklyn and Long Island. Lindsey Moses, MD, who completed her otolaryngology residency at NYU Langone, will return in September 2022 to lead the Head and Neck Cancer Service at Perlmutter Cancer Center—Sunset Park. Alec E. Vaezi, MD, PhD, Clinical Associate Professor of Otolaryngology – Head and Neck Surgery at NYU Grossman School of Medicine and Chief of Head and Neck Surgery at NYU Hospital Langone – Long Island, recently joined the team to develop the service at Perlmutter Cancer Center at NYU Langone – Long Island Hospital. Moses M. Tam, MD, clinical assistant professor in the Department of Radiation Oncology at NYU Long Island School of Medicine, a radiation oncologist dedicated to the treatment of head and neck cancer, recently moved from Brooklyn to Long Island.
“We want to mirror the multidisciplinary care we provide in Manhattan at our other network sites in Brooklyn and Long Island,” says Dr. Jacobson.
Restoring quality of life after facial paralysis
Dr. Jacobson leads a team of surgeons specializing in facial resuscitation, a field focused on preserving – and in some cases restoring – a patient’s facial nerve function after treatment for head and neck cancer. neck. Dr. Jacobson’s team includes Jamie P. Levine, MD, associate professor in the Hansjörg Wyss Department of Plastic Surgery at NYU Grossman School of Medicine and chief of microsurgery; Judy W. Lee, MD, Clinical Associate Professor of Otorhinolaryngology – Head and Neck Surgery and Director of the Division of Facial Plastic and Reconstructive Surgery at NYU Grossman School of Medicine and Director of the Facial Paralysis Center and resuscitation; and Danielle Eytan, MD, clinical associate professor of otolaryngology – head and neck surgery.
Facial resuscitation surgery is performed in a single stage, which means that Dr. Jacobson’s team operates after surgical oncologists remove a tumor – without waking the patient from anesthesia – during any surgery that may cause the loss or damage to a facial nerve. . In some cases, in which facial paralysis has occurred as a result of surgery for a non-cancer issue, the facial animation team performs the surgery as part of a separate procedure.
Caring for a patient with head and neck cancer is very complex, says Allison Most, DNP, FNP-BC, Nurse Practitioner Manager, because of the changes in function and appearance they go through. .
“I love working with facial resuscitation patients because we can only make them better,” says Dr. Most. “It’s always wonderful when patients come to tell us that they attended a child’s or grandchild’s wedding and were able to smile better or were just happier with how they looked. “
Innovative surgical techniques to minimize side effects
Treatments for head and neck cancer include surgery, radiation therapy, chemotherapy, and targeted drugs. Thyroid cancer, for example, can be treated by completely removing the thyroid gland through a surgical procedure called thyroidectomy, if the cancer is caught early. However, thyroidectomy requires an incision in the central region of the lower neck, which can leave thick, raised scars called keloids or hypertrophic scars in some patients. To avoid potential scarring, Michael J. Persky, MD, Clinical Associate Professor of Otorhinolaryngology – Head and Neck Surgery and Director of Robotic Head and Neck Surgery, collaborates with Insoo Suh, MD , an associate professor in the Department of Surgery at NYU Grossman School of Medicine, and performing a new technique at Perlmutter Cancer Center called the Transoral Endoscopic Thyroidectomy-Vestibular (TOTEVA) approach. Studies have shown that this minimally invasive procedure, which avoids neck scarring by allowing surgeons to remove the thyroid through three incisions in the lip, is safe for patients.
“People with thyroid cancer should be aware that TOTEVA is not the standard of care or a conventional thyroid removal procedure,” says Dr. Persky. “However, the procedure is safe and will likely, at some point in the future, become the standard of care for thyroid removal.”
Dr. Persky recommends TOTEVA for people with thyroid nodules that are small cancers or for people with indeterminate nodules that could be cancer and don’t have extensive disease. TOTEVA is also recommended for people with early-stage thyroid cancer, which includes the majority of thyroid cancer cases.
To minimize the side effects of chemotherapy and radiation therapy in treating cancer of the oropharynx, which forms in the back of the throat, Dr. Persky took the approach of performing primary or curative robotic surgery for patients in the early stages of the disease to avoid using radiation. If radiation therapy is needed after surgery, lower doses are used to minimize side effects.
“Radiation therapy and chemotherapy applied to the back of the throat can lead to deep, long-lasting, and increasing difficulties with swallowing and dry mouth,” says Dr. Persky. “Although we cannot eliminate these side effects, if we can offer primary surgery and avoid radiation therapy, the morbidity may be much lower than in patients requiring radiation therapy.”
Clinical trials aim to reduce radiation side effects and improve outcomes
Radiation therapy and chemotherapy, often given together for head and neck cancers, can cause side effects that affect a person’s ability to swallow or cause dry mouth or hearing loss. Clinical trials for people with head and neck cancer focus on reducing these side effects and improving outcomes.
For human papillomavirus (HPV)-associated oropharyngeal cancer, Perlmutter Cancer Center researchers are studying how to reduce or de-escalate the amount of radiation and chemotherapy a patient receives during treatment. The goal of de-escalation is to reduce the toxicity of the treatment, which can lead to a painful side effect called oral mucositis (inflammation of the mucous membranes in the mouth).
“People with HPV-induced oropharyngeal cancer have a very good prognosis, especially if the cancer is confined to the head and neck,” says Zujun Li, MD, clinical associate professor of otolaryngology. -laryngology – head and neck surgery at NYU Grossman School of Medicine. “We want to de-intensify radiation and chemotherapy in these patients to reduce side effects without affecting the cure rate.”
Some head and neck cancers, such as laryngeal cancer, are associated with smoking and alcohol consumption and have a poorer prognosis. Laryngeal cancer is often treated by surgical removal of the voice box, which destroys the patient’s ability to speak. An alternative treatment, Dr. Li says, uses radiation therapy and chemotherapy, which has a 60 to 70 percent cure rate. A clinical trial is currently underway to determine whether the addition of immunomodulatory agents, which boost the body’s immune response against cancer, can improve outcomes in these patients.
HPV-associated cancers secrete biomarkers, which can be measured in the blood using a commercially available test, and show the presence of active disease. Dr. Hu is leading a clinical trial at the Perlmutter Cancer Center to use this test to adjust radiation dose based on the level of circulating tumor DNA during treatment. Patients in the trial will undergo an HPV DNA measurement before treatment and then after four weeks of radiation therapy. Dr. Hu says the level of circulating HPV DNA can guide radiation oncologists to adjust the amount of radiation needed to kill tumors.
“There has been a lot of interest in a commercially available test to see if we can use it as a way to monitor patients,” says Dr Hu. “There is exciting data supporting the use of this test for HPV positive patients who have detectable HPV DNA in their blood before they receive treatment.”
Ultimately, Dr. Hu hopes the test can be used for patient monitoring after treatment, reducing the need for PET/CT scans, MRIs and endoscopies to assess whether the cancer has returned.