The changing role of surgery in the current era of head and neck oncology

Excerpt

As in all fields of scientific endeavor, the nature and role of surgery for treatment of neoplastic disease in the head and neck has evolved since the publication of the first textbook on head and neck surgery by Levi Cooper Lane in 1896 [1]. After the discovery that ionizing radiation could destroy malignant tissue, this modality became a preferred treatment for head and neck cancer because it avoided the massive tissue ablation, infection and other morbidities associated with extirpation of head and neck tumors in the pre-antibiotic era. The initial promise of radiation treatment proved to be disappointing, and by the mid 20th century, ablative surgery with en bloc resection of tumors including wide margins of surrounding normal tissue and the draining lymph node basin could be performed with relative safety and became the preferred standard either as initial treatment or for treatment of irradiation failure [2]. The introduction of megavoltage radiotherapy units in the 1950s and subsequent continuous advances in the fields of radiotherapy technology, radiobiology and drug design led to increased use of irradiation and systemic therapy over time [3]. …