Head and Neck Cancer
Spanish Society of Medical Oncology
Hypopharynx
Recommend surgical resection (total pharyngo-laryngectomy + neck dissection) followed by radiotherapy or chemoradiotherapy if there is high risk of recurrence of pathological factors, especially T4a.
Concurrent chemoradiotherapy with 3x-weekly cisplatin is recommended if patient refuses surgery. If cisplatin cannot be administered, then cetuximab concurrent to radiotherapy.
Induction chemotherapy with TPF (docetaxel/cisplatin/fluorouracil) schedule: If complete response: radiotherapy (based on initial stage) ± cisplatin/cetuximab (based on induction chemotherapy [ICT] toxicity). If partial response: surgery followed by radiotherapy or chemoradiotherapy. If the main objective is organ preservation, consider concomitant radiotherapy (RT) (with cisplatin or cetuximab). If stable disease or progression: surgery (including neck dissection) followed by radiotherapy or chemoradiotherapy.
Larynx
Surgical resection (total versus partial laryngectomy + neck dissection) followed by radiotherapy or chemoradiotherapy if there is high risk of recurrence of pathological factors, especially T4a.
Concurrent chemoradiotherapy with 3x-weekly cisplatin is recommended if patient refuses surgery. If cisplatin cannot be administered, then cetuximab concurrent to radiotherapy.
Induction chemotherapy with TPF schedule: If complete response: radiotherapy. If partial response: concomitant RT (with cisplatin or cetuximab) or consider surgery followed by radiotherapy. If stable disease or progression: surgery (including neck dissection) followed by radiotherapy or chemoradiotherapy.
Oropharynx
Concurrent chemoradiotherapy with 3x-weekly cisplatin is recommended. If cisplatin cannot be administered, then cetuximab concurrent to radiotherapy.
Consider induction chemotherapy with TPF schedule only in those patients with N bulky and fast tumor growth, individualizing benefit and toxicity.
For unresectable locally advanced disease, different therapeutic strategies have been explored:
For concomitant chemoradiotherapy with 3x-weekly cisplatin, several studies have demonstrated benefit in locoregional control and overall survival over radiotherapy alone with a significant increase in acute and chronic toxicity.
Concomitant radiotherapy and cetuximab have shown a benefit in locoregional control and overall survival compared to radiotherapy alone with a better toxicity profile compared to chemotherapy. It should be considered if the use of cisplatin is contraindicated (eg, neuropathy, nephropathy, heart disease, and hearing loss).
Induction chemotherapy followed by locoregional treatment. This option has been reconsidered, especially in patients who require rapid response or are at increased risk of distant metastases.
Reference
Iglesias D, Arrazubi AV, Baste RN, et al. SEOM clinical guidelines for the treatment of head and neck cancer (2017). Clin Transl Oncol. 2017 Nov 20. https://link.springer.com/article/10.1007%2Fs12094-017-1776-1
Medscape © 2017 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: John Anello, Brian Feinberg, John Heinegg, et. al. New Clinical Practice Guidelines, December 2017 - Medscape - Dec 06, 2017.
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