Treatment Goals and Treatment Alternatives The Role of Multidisciplinary Treatment

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Cure is the goal of treatment for most patients without distant metastases. Prognosis depends upon disease stage, histology, and biological factors such as degree of angiogenesis.9,14-16 Palliation of symptoms is a secondary goal for patients with curable disease and a primary goal for patients with distant metasta-tic disease. Palliative approaches range from supportive care to chemotherapy, radiation therapy and, rarely, surgical intervention.

The optimal management of nasopharynx cancer requires multidisciplinary collaboration. A head and neck surgeon often makes the diagnosis and performs the necessary biopsies. The patient should be referred to a radiation oncologist as soon as the diagnosis is established, as radiotherapy is the foundation of curative treatment. A medical oncologist should

Figure 7-2. Magnetic resonance images (MRI) of an advanced nasopharyngeal cancer. A, Axial T2-weighted image with fat suppression demonstrating a large, left-sided nasopharynx tumor with parapharyngeal extension and skull base invasion. B, Sagittal T1-weighted image of the same tumor.

Table 7-1. 1997 AJCC/UICC NASOPHARYNGEAL CANCER STAGE CLASSIFICATION

T Stage Primary Tumor Extent

T1 Confined to the nasopharynx

T2 Extends to oropharynx or nasal cavity 2a Without parapharyngeal extension 2b With parapharyngeal extension

T3 Invades bones or paranasal sinuses

T4 Involvement of cranial nerves, intracranial contents, infratemporal fossa, hypopharynx or orbit

NO No lymph node metastases

N1 Unilateral lymph node(s) < 6 cm

N2 Bilateral lymph nodes < 6 cm

N3 Metastases in lymph nodes 3a Greater than 6 cm

3b With extension to the supraclavicular fossa

I T1 NO MO

IIA T2a NO MO

IIB T2b NO MO

T1-T2b N1 MO

III T3 NO-1 MO

T1-T3 N2 MO

IVA T4 NO-2 MO

IVB T1-4 N3 MO

Data from: L. Sobin and C. Wittekind, editors, UICC, TNM classification of malignant tumors. 5th ed. New York: Wiley-Liss; 1997.

also be consulted because the role of chemotherapy is increasing in the treatment of this disease. Other important members of the multidisciplinary team include the radiologist, pathologist, and dentist. Specialized nurses, dieticians, occupational therapists and counselors may also provide useful services.

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