PERSPECTIVESPanelists Ardeshir Ghavamzadeh Tehran Barbara Wollenberg Lübeck Frank Riedel Mannheim...

PERSPECTIVESPERSPECTIVESPanelistsPanelists

Ardeshir Ghavamzadeh TehranArdeshir Ghavamzadeh TehranBarbara Wollenberg LübeckBarbara Wollenberg Lübeck

Frank Riedel MannheimFrank Riedel MannheimBarbara Burtness PhiladelphiaBarbara Burtness Philadelphia

Thomas J. Vogl FrankfurtThomas J. Vogl FrankfurtJan Olofsson BergenJan Olofsson Bergen

Frankfurt 2008

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PERSPECTIVESPERSPECTIVESRadiotherapyRadiotherapy

SurgerySurgeryNeoadjuvant ChemotherapyNeoadjuvant Chemotherapy

ChemoradiotherapyChemoradiotherapyMolecular Therapy-Targeted therapy:Molecular Therapy-Targeted therapy:

Tyrosine kinase inhibitorsTyrosine kinase inhibitorsEGFR inhibitorsEGFR inhibitorsVEGF inhibitorsVEGF inhibitorsCox-2 inhibitorsCox-2 inhibitors

Genetically steared therapyGenetically steared therapyHPV-vaccinationHPV-vaccination

Individualized tailor-made therapy?Individualized tailor-made therapy?How to select the therapy?How to select the therapy?

Function, QOL, and Cost of treatmentFunction, QOL, and Cost of treatment Frankfurt 2008

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PERSPECTIVESPERSPECTIVES

Certain restrictions in medical research Certain restrictions in medical research and the ethical debate concerning use of and the ethical debate concerning use of human tissue and biobank laws may be human tissue and biobank laws may be obstacles to overcome in coming years obstacles to overcome in coming years especially for international multicenter especially for international multicenter studies.studies.

Frankfurt 2008

PerspectivesPerspectives

Head and neck cancer treatment is and Head and neck cancer treatment is and will be a team therapy where insight in will be a team therapy where insight in tumour biology, pharmacodynamics, tumour biology, pharmacodynamics, molecular genetics and modern molecular genetics and modern technology in imaging as CT – PET, technology in imaging as CT – PET, radiotherapy, surgery and chemotherapy radiotherapy, surgery and chemotherapy may be have to be taken into account.may be have to be taken into account.

Frankfurt 2008

PerspectivesPerspectives

A non-smoking, HPV-vaccinated world A non-smoking, HPV-vaccinated world may hopefully change the incidence of may hopefully change the incidence of certain cancers and may definitely change certain cancers and may definitely change focus in head and neck cancer therapy. focus in head and neck cancer therapy.

Frankfurt 2008

Advanced training in head and Advanced training in head and neck oncology/surgery in Europeneck oncology/surgery in Europe

Frankfurt 2008


Most head and neck surgeons come from Most head and neck surgeons come from ORL.ORL.

Some head and neck surgeons come from Some head and neck surgeons come from Maxillofacial Surgery as in GB, Spain, Maxillofacial Surgery as in GB, Spain, Slovakia.Slovakia.

Some head and neck surgeons come from Some head and neck surgeons come from General Surgery as in Belgium, Slovakia.General Surgery as in Belgium, Slovakia.

Frankfurt 2008


In most countries there are not In most countries there are not any organised advanced any organised advanced training – fellowships - as in training – fellowships - as in Poland, Germany, Italy, Nordic Poland, Germany, Italy, Nordic countries (except for Finland countries (except for Finland where it is starting up).where it is starting up).

Frankfurt 2008


Hungary has a national oncological Hungary has a national oncological institute in Budapest and regular courses institute in Budapest and regular courses in head and neck oncology.in head and neck oncology.

Belgium - some half-time fellowships.Belgium - some half-time fellowships.

Spain - two fellowships per year, H. Sant Spain - two fellowships per year, H. Sant Pau in Barcelona and H. Central de Pau in Barcelona and H. Central de Asturias.Asturias.

Frankfurt 2008


Finland (UEMS):Finland (UEMS):

Newly suggested ”fellowship” programme.Newly suggested ”fellowship” programme.

Accepted by the University clinics.Accepted by the University clinics.

Two years training programme.Two years training programme.

Training master.Training master.

Licenced ORL – specialist.Licenced ORL – specialist.

At least 18 months ORL – HNS.At least 18 months ORL – HNS.

Frankfurt 2008


Six months may be performed in Six months may be performed in maxillofacial surgery, oral surgery, plastic maxillofacial surgery, oral surgery, plastic surgery or oncology.surgery or oncology.

Final examination.Final examination.

Not a separate legally valid licence.Not a separate legally valid licence.

Frankfurt 2008


Aims:Aims:Good knowledge in: Good knowledge in:

- Prevention and Early Diagnosis- Prevention and Early Diagnosis- Diagnostic methods for diagnosing and treatment - Diagnostic methods for diagnosing and treatment

planningplanning- Experience treatment and rehabilitation planning - Experience treatment and rehabilitation planning

and be able to act as chairman for a multi- and be able to act as chairman for a multi- disciplinary head & neck oncology groupdisciplinary head & neck oncology group

- Surgical treatment of head & neck tumours- Surgical treatment of head & neck tumours- Participation in planning of new treatment - Participation in planning of new treatment

modalitiesmodalities

- Evaluation of treatment results using scientific - Evaluation of treatment results using scientific methodsmethods

Frankfurt 2008


Theoretical trainingTheoretical training- Interdisciplinary weekly planning - Interdisciplinary weekly planning

meetingsmeetings- Educational sessions of the University - Educational sessions of the University

HospitalHospital- Working group meetings- Working group meetings- 60 hours theoretical courses including - 60 hours theoretical courses including

meetings as SSHNO, AHNS, EHNSmeetings as SSHNO, AHNS, EHNS

Frankfurt 2008


United Kingdom:United Kingdom:Interface training set up by RCS LondonInterface training set up by RCS LondonTwo year programmeTwo year programmeFive centres identifiedFive centres identifiedApplications, site visit, interviewsApplications, site visit, interviewsPlanned for ENT, Oral, Max.Fac. Planned for ENT, Oral, Max.Fac. Surgeons and Plastic SurgeonsSurgeons and Plastic Surgeons

Frankfurt 2008


Up to now ENT and Max.Fac. Surgery Up to now ENT and Max.Fac. Surgery onlyonlyA few candidates have come out of this A few candidates have come out of this systemsystemMost time spent in parent speciality, but Most time spent in parent speciality, but some time in other specialitiessome time in other specialities

References:References: Graham John Cox: Training in Head and Neck Surgery. ENT News, vol. 12, no. 4, 51, 2003.Graham John Cox: Training in Head and Neck Surgery. ENT News, vol. 12, no. 4, 51, 2003. John Watkinson: Comments on the Interface Head & Neck Oncological Training Fellowships in John Watkinson: Comments on the Interface Head & Neck Oncological Training Fellowships in

the United Kingdom. ENT News , vol. 14, no. 4, 42-46, 2005.the United Kingdom. ENT News , vol. 14, no. 4, 42-46, 2005.

Frankfurt 2008


The Netherlands:The Netherlands:

Advanced training in H & N Oncology and Advanced training in H & N Oncology and SurgerySurgery

Aims: Guarantee high quality care for Aims: Guarantee high quality care for

H & N Cancer patientsH & N Cancer patients

Frankfurt 2008


Training approved by the General Training approved by the General Assembly ORL-Soc. which determines the Assembly ORL-Soc. which determines the number of training institutionsnumber of training institutions

Two years continous trainingTwo years continous training

Specialist in ORLSpecialist in ORL

Member Dutch Society ORL-HNSMember Dutch Society ORL-HNS

Frankfurt 2008


Training:Training:- Diagnosis, treatment, rehabilitation in - Diagnosis, treatment, rehabilitation in

H&N tumour patients as well as H&N tumour patients as well as premalignant lesionspremalignant lesions

- Six weeks at the Dept of Radiotherapy- Six weeks at the Dept of Radiotherapy- Six weeks at the Dept of Medical - Six weeks at the Dept of Medical

OncologyOncologyFrankfurt 2008


Certification as Head & Neck Surgeon/ Certification as Head & Neck Surgeon/ OncologistOncologist

Certification valid for five yearsCertification valid for five years

Re-registration after this periodRe-registration after this period

Frankfurt 2008


Summation:Summation:Few countries with organised advanced training in Few countries with organised advanced training in EuropeEuropeEHNS must have such organised training as one of its EHNS must have such organised training as one of its primary aimsprimary aimsMultidisciplinary approachMultidisciplinary approachStimulate recruitment by Stimulate recruitment by

- good planning- good planning- scientific possibilities- scientific possibilities- regular meetings in Europe- regular meetings in Europe- international collaboration in and outside Europe- international collaboration in and outside Europe

- international fellowships- international fellowships

Frankfurt 2008

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PERSPECTIVESPanelists Ardeshir Ghavamzadeh Tehran Barbara Wollenberg Lübeck Frank Riedel Mannheim...

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