Oral cavity cancer: The depth of invasion has been incorporated into the update, and will now increase the T category by one step for every 5 mm of invasion, Dr. Kraus said.
Explore This IssueJune 2017
Dr. Kraus hopes the staging changes will improve care. “I think this will have a significant impact on our patients [and] a significant impact upon where we decide to both intensify and de-intensify patient care.”
In another segment of the panel session, J. Scott Magnuson, MD, the chief medical officer of the Florida Hospital Nicholson Center in Celebration, Fla., said the onward march continues in robotic surgery, fueled by new technology geared toward augmenting the knowledge and skill of human experts; new financial models in which price is aligned with value and that promote technology that will lower the cost of treatment rather than increase it; and new roles for surgeons in which this technology could help boost the patient–provider ratio.
Dr. Magnuson said that most of the robotic surgery technology now in use is at Level 1, which allows the operator to keep continuous control of the system while the robot helps in some way. However, there are already robots made, although these are not yet commercially available, that are at a Level 3. At this level, the operator selects and approves a plan, and the robot performs the procedure automatically under close supervision. One such robot can suture after the surgeon sets it up, he added.
Another robot in the design phase is being devised to reach a Level 4—it is even able to make decisions, although it’s still under close supervision. “The ‘surgical cockpit’ is really the future for us,” Dr. Magnuson said. “If we’re to compare this to the airline industry and what pilots have— they’ve gone from manual control to computer controls to where the plane is flown automatically.”
Ravi Uppalurri, MD, PhD, director of head and neck surgical oncology at the Dana Farber Cancer Institute in Boston, discussed the evolving role of checkpoint inhibition in the treatment of head and neck cancer, including the use of these therapies prior to surgery.
The therapies—which include nivolumab and pembrolizumab—have been shown to overcome the way in which a tumor can blunt the body’s immune response to cancer. They essentially “release the brakes” in the immune system’s fight against the tumor and have been shown to have lasting responses.
Some patients have had dramatic success with these types of therapy, with complete eradication of cancer in the neck, he said. “Ultimately, these kinds of vignettes really need to be confirmed with larger trials,” he added. “But I think these kinds of neoadjuvant approaches are really going to change how we manage our patients.”