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KATHRYN M VAN ABEL: We've seen one type of cancer really start to rise within the head and neck, and that's oropharynx or throat cancer. We are one of the first centers that really worked on and focused on de-escalating cancer therapy for patients with oropharynx cancer. That allows us to really tailor treatment for patients and really try and optimize who is a good candidate for de-escalation and who isn't to be able to number one cure that patient of their cancer and number two, try and maximize their functional outcome.
ERIC J MOORE: We've had a lot of instrumentation that's been developed that we've utilized and that's helped us to do transoral surgeries. That's part of the de-escalation pathway in many of the tumors that we used to treat surgically. But that we used to make large incisions through the neck, or incisions even through the jawbone to get things out of the way, we can now take out through the mouth for a procedure where you can go home the next day versus having to stay in the hospital for five or six days.
DANIEL J MA: Here at Mayo Clinic, our focus has been seeing how we can leverage all the treatment options available to us. Minimally invasive surgery, focused radiation therapy, gentler chemotherapy to create a total treatment package that maintains cure but reduces side effects. We had the most focused radiation therapy techniques, including proton therapy, daily imaging, very focused ARC therapy, all in very experienced hands for treating head and neck cancer.
Multiple studies have now shown that, for head and neck radiation specifically, having a high volume center with sub-specialists looking at the radiation fields and the radiation techniques used for treatment has an impact on outcome. Not just on toxicity outcome, but on disease outcomes as well. Instead of the standard six weeks of 60 gray worth of radiation treatment, we would follow that up with a treatment course of two weeks of 30 to 36 gray of radiation treatment.
Instead of the traditional chemotherapy of cisplatin, it would be a gentler chemotherapy docetaxel given at a lower dose. And we have published on our phase II trial results demonstrating that this regimen maintains historical control rates but has excellent long term toxicity rates with the grade 3 toxicity rate past two years of less than 3%.
KATHRYN M VAN ABEL: Significant improvement in swallowing outcomes, decrease in dry mouth, and decrease reliance on any additional route for getting calories in like a PEG tube. And we were able to identify some patients that are at higher risk of developing recurrence, which allows us to further strategize how we can individualize therapy for patients.
ERIC J MOORE: we try to provide 48 hour turnaround in those appointments, and we try to get that patient in the wake of the request. And we try to get them into treatment in general, having everything ready to go with all of the plan made and having them see all those providers, within two weeks.
The patient can come and get a biopsy, and a diagnosis, and a PET scan, and see four different specialists and get a treatment plan in four hours. The team concept of care, the systems that are in place here, the cancer center resources that allow that to happen are really what differentiate us and what make it valuable for a patient to leave their home environment to come here.
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