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Fellowship Curriculum Overview

The overall goal of this program is for the candidate to develop proficiency in the management of patients with head and neck cancer including knowledge of the disease processes, diagnosis and evaluation, surgical procedures, other treatment modalities, and rehabilitation.

The specific objectives include: a thorough knowledge of the full spectrum of surgical procedures for treating head and neck cancer; understanding combined treatment modalities; becoming familiar with the process of multidisciplinary treatment planning; managing patients undergoing various types of chemoradiation; management of thyroid and parathyroid disease; becoming familiar with rehabilitation techniques and approaches aimed at overcoming various dysfunctions precipitated by head and neck cancer; and developing the necessary research skills to become a successful academician.

The fellowship is sponsored by the Simmons Cancer Institute at SIU and the Division of Otolaryngology-Head and Neck Surgery. The length of the fellowship will be 2 years during which time, 50% effort will be devoted to translational laboratory reseach. The Division provides a comprehensive training program for otolaryngology residents who participate in the care of patients within its affiliated hospitals. The head and neck oncology fellowship is an integral part of the training program sponsored by the division, and encompasses the clinical activity related to cancer care.

Approximately 250 new cancer patients are referred to the institution for management each year. A large proportion of the referrals are patients with advanced upper aerodigestive tract lesions who require multimodality therapy. The weekly treatment planning conference involves the multidisciplinary input from specialists representing surgical oncology, radiation oncology, medical oncology, endocrinology, neuroradiology, pathology, speech and swallowing, social work, and nutrition. Reconstructive surgery, including free tissue transfer, is done by Drs. Michael W. Neumeister and Dr. Nada Berry. Laryngeal rehabilitation surgery is done by Dr. Gayle Woodson. Fellows have an opportunity to become involved in all aspects of management.

Translational laboratory research in head and neck cancer is under the direction of Krishna Rao MD, PhD and other members of the research team at Simmons Cancer Institute. Currently, the head and neck translational research laboratory is supported by endowment funding with an emphasis on mechanisms of chemo resistance. Clinical trials research is also ongoing with Dr. Robbins and Dr. Rao, and the candidate is encouraged to participate.

A formal education program includes weekly patient care rounds, treatment planning conference, grand rounds, and protocol reviews. There are also biweekly research meetings, didactic lectures, and monthly journal clubs.

Advanced Fellowship Training in Head & Neck Surgical Oncology

Educational Objectives

1. Develop an in-depth knowledge of all benign and malignant neoplasms of the head and neck including carcinomas of the upper aerodigestive tract, salivary gland tumors, thyroid and parathyroid disease, cutaneous malignancies, and skull base tumors.

2. Understand the basic science principles of tumors including carcinogenesis, tumor growth and metastases, immunology, nutrition, radiation biology, chemotherapy, and molecular biology.

3. Develop skills in assessing patients with head and neck cancer including history taking, physical examination techniques, interpretation of radiological studies, and endoscopy of the upper aerodigestive tract.

4. Achieve proficiency in performing surgical procedures required for treating head and neck cancer including: exposure techniques for tumors of the paranasal sinuses, pharynx, mediastinum, and skull base; endoscopic laser microsurgery, conservation procedures for laryngeal cancer; modifications of cervical lymphadenectomy; and reconstructive techniques including free tissue transfer.

5. Acquire a sound knowledge of other treatment modalities for head and neck cancer including radiation therapy, chemotherapy, immunotherapy, photodynamic therapy. Develop a full understanding of how to combine various treatments and become familiar with the process of multidisciplinary treatment planning.

6. Achieve an in depth experience for managing patients undergoing targeted chemoradiation including patient selection, acute care, management of toxicities, and follow-up evaluations.

7. Understand the impact of head and neck cancer and its treatment on speech (phonation, articulation), swallowing including mastication, respiration, taste and smell, cosmesis, and psychosocial issues. Become familiar with rehabilitation techniques and approaches aimed at overcoming various dysfunctions precipitated by the disease process. 8. Acquire skills for developing clinical trials and protocols including an understanding of basic principles of statistics, data acquisition and management.

Goals for Future Career Development

1. Participate in a multidisciplinary setting as a head and neck surgical oncologist to provide state of the art care for patients with head and neck cancer.

2. Collaborate with oncology colleagues to conduct clinical trials and other prospective research endeavors to improve the understanding of head and neck cancer and its management.

3. Teach other physicians and students about head and neck cancer to improve the medical community’s awareness and understanding of the disease.

4. Teach other surgery residents the necessary expertise to become skilled and knowledgeable head and neck surgical oncologists.