Jeroen Meulemans
Jeroen Meulemans graduated as a medical doctor at KU Leuven (Belgium) in 2010, and subsequently started training in otolaryngology and head and neck surgery. In 2015, he joined the staff of the department of otolaryngology, head and neck surgery in UZ Leuven and proceeded with finetuning his clinical experience by observerships in Brescia (It), Genova (It), Milan (It), Stuttgart (Germany), Seoul (S-Korea) and Vienna (Austria). He was awarded the Liechtenberger price by the European Laryngological Society in 2016 and the Young Investigator’s award by the European Head and Neck Society in 2023. In 2021, he obtained his PhD degree in Biomedical Sciences after successful defence of his thesis entitled: ‘Innovative surgical techniques in head and neck oncology – current technologies and applications and developments for the future’. He has a special interest in surgical treatment of thyroid cancer, in minimally-invasive (transoral) robotic and laser surgery of head and neck cancer and in reconstruction of laryngotracheal stenoses. Moreover, he is involved in the tracheal transplantation programme. His research focuses on evaluation of oncological and functional outcomes after primary minimally invasive surgery for head and neck cancer and after salvage surgery for recurrent cancers of the upper aerodigestive tract.
Session
The management of head and neck cancer (HNC) requires a multidisciplinary, guideline-driven approach to optimize outcomes and minimize morbidity. Unfortunately, a subset of patients is still being treated outside of established protocols, often leading to suboptimal oncologic control, functional impairments, and complex salvage scenarios. This retrospective clinical reflection highlights several emblematic cases of inadequately treated HNC patients referred to our center for secondary management.
Our analysis focuses on patients who initially underwent incomplete, inappropriate, or delayed treatment in non-specialized centers. Common issues included: lack of proper staging before treatment, non-standard surgical approaches without clear margins, omission of adjuvant therapy when indicated, or poorly planned radiotherapy. These deviations frequently resulted in early recurrence, persistent disease, or major complications involving speech, swallowing, and airway integrity.
Through selected clinical cases, we explore the practical, ethical, and therapeutic challenges involved in managing these patients. Salvage treatments – whether surgical, radiotherapeutic, or systemic – are often technically more demanding and oncologically less effective than primary treatments delivered within guidelines. In addition, prior suboptimal treatment often compromises anatomical structures and patient performance status, making optimal recovery difficult.
This clinical case-based review also raises broader questions regarding referral practices, the role of second opinions, and the need for early multidisciplinary evaluation. It aims to prompt reflection among clinicians on the consequences of deviating from evidence-based care in HNC and to encourage systemic improvements in patient pathways. We also emphasize the psychological burden these patients carry and the difficulty in restoring their trust after prior mismanagement.
Ultimately, while reconstructive and salvage interventions are necessary and sometimes life-saving, they are rarely equivalent to getting it right the first time. Prevention, through timely referral and coordinated care in high-volume, specialized centers, remains the most effective and ethical solution.