When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base

Internal or common carotid artery encasement (CAE) is observed in almost 2-7% of head and neck cancers (HNC) and designates the tumor with the T4b category. This clinical scenario is associated with a dismal prognosis, owing to the risk for thrombosis and bleeding that usually characterizes such an...

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Autores principales:	Ester Orlandi, Marco Ferrari, Elvis Lafe, Lorenzo Preda, Marco Benazzo, Barbara Vischioni, Maria Bonora, Vittorio Rampinelli, Alberto Schreiber, Lisa Licitra, Piero Nicolai
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	head & neck cancer encasement involvement carotid skull base (head and neck) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/2004124760724c36b62dd431bfd17d5e
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spelling	oai:doaj.org-article:2004124760724c36b62dd431bfd17d5e2021-11-18T05:00:34ZWhen Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base2234-943X10.3389/fonc.2021.781205https://doaj.org/article/2004124760724c36b62dd431bfd17d5e2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.781205/fullhttps://doaj.org/toc/2234-943XInternal or common carotid artery encasement (CAE) is observed in almost 2-7% of head and neck cancers (HNC) and designates the tumor with the T4b category. This clinical scenario is associated with a dismal prognosis, owing to the risk for thrombosis and bleeding that usually characterizes such an advanced cancer. Standardized radiological criteria to infer invasion of the carotid artery are lacking. Complete surgical resection in the context of a multimodality treatment is supposed to offer the greatest chances of cure. Surgery can either be carotid-sparing or include carotidectomy. Data on probability of cerebrovascular and non-cerebrovascular complications, risk of carotid blowout, poor oncologic outcomes, and less-than-certain efficacy of diagnostic and interventional preventive procedures against cerebral infarction make it difficult to define surgery as the recommended option among other therapeutic strategies. Non-surgical therapies based on radiation therapy possibly combined with chemotherapy are more frequently employed in HNC with CAE. In this context, carotid blowout is the most feared complication, and its probability increases with tumor stage and cumulative radiation dose received by the vessel. The use of highly conformal radiotherapies such as intensity-modulated particle therapy might substantially improve the manageability of HNC with CAE by possibly reducing the risk of late sequalae. Despite evidence is frail, it appears logical that a case-by-case evaluation through multidisciplinary decision making between head and neck surgeons, radiation oncologists, medical oncologists, diagnostic and interventional radiologists, and vascular surgeons are of paramount value to offer the best therapeutic solution to patients affected by HNC with CAE.Ester OrlandiMarco FerrariMarco FerrariMarco FerrariElvis LafeElvis LafeLorenzo PredaLorenzo PredaMarco BenazzoBarbara VischioniMaria BonoraVittorio RampinelliVittorio RampinelliAlberto SchreiberLisa LicitraPiero NicolaiFrontiers Media S.A.articlehead & neckcancerencasementinvolvementcarotidskull base (head and neck)Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	head & neck cancer encasement involvement carotid skull base (head and neck) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	head & neck cancer encasement involvement carotid skull base (head and neck) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Ester Orlandi Marco Ferrari Marco Ferrari Marco Ferrari Elvis Lafe Elvis Lafe Lorenzo Preda Lorenzo Preda Marco Benazzo Barbara Vischioni Maria Bonora Vittorio Rampinelli Vittorio Rampinelli Alberto Schreiber Lisa Licitra Piero Nicolai When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base
description	Internal or common carotid artery encasement (CAE) is observed in almost 2-7% of head and neck cancers (HNC) and designates the tumor with the T4b category. This clinical scenario is associated with a dismal prognosis, owing to the risk for thrombosis and bleeding that usually characterizes such an advanced cancer. Standardized radiological criteria to infer invasion of the carotid artery are lacking. Complete surgical resection in the context of a multimodality treatment is supposed to offer the greatest chances of cure. Surgery can either be carotid-sparing or include carotidectomy. Data on probability of cerebrovascular and non-cerebrovascular complications, risk of carotid blowout, poor oncologic outcomes, and less-than-certain efficacy of diagnostic and interventional preventive procedures against cerebral infarction make it difficult to define surgery as the recommended option among other therapeutic strategies. Non-surgical therapies based on radiation therapy possibly combined with chemotherapy are more frequently employed in HNC with CAE. In this context, carotid blowout is the most feared complication, and its probability increases with tumor stage and cumulative radiation dose received by the vessel. The use of highly conformal radiotherapies such as intensity-modulated particle therapy might substantially improve the manageability of HNC with CAE by possibly reducing the risk of late sequalae. Despite evidence is frail, it appears logical that a case-by-case evaluation through multidisciplinary decision making between head and neck surgeons, radiation oncologists, medical oncologists, diagnostic and interventional radiologists, and vascular surgeons are of paramount value to offer the best therapeutic solution to patients affected by HNC with CAE.
format	article
author	Ester Orlandi Marco Ferrari Marco Ferrari Marco Ferrari Elvis Lafe Elvis Lafe Lorenzo Preda Lorenzo Preda Marco Benazzo Barbara Vischioni Maria Bonora Vittorio Rampinelli Vittorio Rampinelli Alberto Schreiber Lisa Licitra Piero Nicolai
author_facet	Ester Orlandi Marco Ferrari Marco Ferrari Marco Ferrari Elvis Lafe Elvis Lafe Lorenzo Preda Lorenzo Preda Marco Benazzo Barbara Vischioni Maria Bonora Vittorio Rampinelli Vittorio Rampinelli Alberto Schreiber Lisa Licitra Piero Nicolai
author_sort	Ester Orlandi
title	When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base
title_short	When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base
title_full	When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base
title_fullStr	When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base
title_full_unstemmed	When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base
title_sort	when everything revolves around internal carotid artery: analysis of different management strategies in patients with very advanced cancer involving the skull base
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/2004124760724c36b62dd431bfd17d5e
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When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base

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