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The surgeon who wants to make her operations unnecessary

Lotje Zuur sometimes has to perform disfiguring operations. As a head and neck surgeon, she removes parts of the mouth, throat or face of people with cancer. Now a promising treatment may make such operations unnecessary. What would this mean for patients? This is what her inaugural speech on 19 September is about. Zuur is a professor by special appointment at the LUMC.

‘The hardest thing to see in my patients is that in choosing to have their disease treated they are making a huge bet on their future when it is very uncertain whether they will still be alive in two years’ time.’ Lotje Zuur means that in exchange for a 20-50 per cent chance of surviving the next two years’ time, her patients sacrifice their larynx, a significant part of their tongue or jaw, an eye or an ear, or another part of their face. ‘That has huge ramifications. People sometimes fall into social isolation or can no longer speak or eat properly, for instance. And that for a relatively low survival rate.’

Several hundred people a year

Zuur is a head and neck surgeon at the Antoni van Leeuwenhoek hospital in Amsterdam and for a year now has been Professor by Special Appointment Otorhinolaryngology at the ENT and Head and Neck Surgery Department at the Leiden University Medical Center. One of the most common forms of head and neck cancer is squamous cell carcinoma of the mouth and throat – often caused by smoking and alcohol consumption or human papillomavirus. This form affects several hundred people a year in the Netherlands. At least as many squamous carcinomas on the skin of the head and neck also occur in the elderly, due to UV rays.  

Immunotherapy before surgery: you can’t believe your eyes

Since 2016, Zuur and her colleagues have been studying what happens when, in the period before extensive surgery and radiotherapy, patients are given two courses of a type of immunotherapy known as neoadjuvant immunotherapy. It seems that in a large number of patients the cancer has almost or completely vanished by the time of the surgery. ‘As a surgical oncologist you can’t believe your eyes,’ says Zuur. ‘Sometimes the tumour has completely gone by the time of surgery, after just two courses of immunotherapy in just four weeks!’

Patients refuse surgery

Some patients in the study even refused radical surgery and radiotherapy upon discovering that the immunotherapy had caused the cancer to disappear completely. Mr B., for example, aged 91, as shown in the photo. ‘His cheek, upper jaw and eye were to be removed, but he kindly but firmly refused the surgery and radiotherapy afterwards. Two years later, he is still cancer-free.’

Money is the issue

As far as Zuur is concerned, this promising finding leads to a crucial new research question for these patients. If short-term immunotherapy completely eliminates the tumour in these patients, perhaps disfiguring surgery and radiotherapy should no longer be standard. Zuur is keen to start clinical trials to see if short-course immunotherapy can lead to a cure. ‘Strangely enough, this type of research does not fit so easily within the framework of the usual funds, mainly because within such a study we also have to cover the healthcare costs. We still need a few grand and are going to do our very best to raise this,’ says Zuur. 

Lotje Zuur will give her inaugural lecture Onder het mes of achter de hand? (Under the knife or backup plan?) on Monday 19 September. More info and registration.

Text: Rianne Lindhout
Picture: Pexels

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