Precision medicine in head and neck oncology using innovative techniques

Personalized oncologic therapy of head and neck tumours can achieve remarkable therapeutic success through close interdisciplinary collaboration between surgeons, pathologists and radiation oncologists pre-, intra-, and postoperatively. Here, virtual surgical planning (VSP) and its translation into operating theater by prefabricated surgical resection or osteotomy guides in combination with patient-specific implants have contributed to a high level of accuracy, leading to a more precise prediction of the reconstructive result and contribute an optimized esthetic outcome. The additional use of intraoperative assistance systems such as confocal fluorescence laser microscopy and optical navigation can also improve the control of resection margins, due to an enhancement of safe oncological resection by creation of tumor resection maps. Since resection status is an important prognostic factor, the use of these data enables a targeted post-resection, which can significantly improve patient prognosis. However, the use of navigation data sets is not only of importance for surgery and pathology, but also for the improved spatial assignment of resection margins in the context of radiation planning. Based on these data, an individualization of postoperative radiotherapy (RT) plans with adjusted boost volumes and de-escalation in vulnerable tissues can be achieved. With the additional determination of molecular, genetic and proteomic characteristics, individualized adjuvant therapy as well as follow-up for optimal therapy management can thus be accomplished.