The clinical practice guidelines on head and neck cancers were released in May 2018 by the NCCN.[1]
Treatment of Locoregionally Advanced Disease
Patients with T1,N0,M0 nasopharyngeal tumors should be treated with definitive RT alone, including elective RT to the neck. For patients with locoregionally advanced NPC (T1,N1–3; T2–T4,any N), enrollment in a clinical trial is preferred.
The panel recommends concurrent CRT (cisplatin) with adjuvant chemotherapy (cisplatin/5-FU) for locoregionally advanced NPC. Cisplatin for CRT is recommended for patients with no contraindication to the drug. If using adjuvant chemotherapy, adjuvant carboplatin/5-FU is a widely accepted option.
Induction chemotherapy (followed by CRT) is also recommended for patients with NPC with either T1,N1–3 or T2–T4,any N lesions.
Treatment of Metastatic Disease
For patients with NPC who present with metastatic (M1) disease, enrollment in a clinical trial is preferred. Other recommended initial therapy options include either a platinum-based combination systemic therapy regimen or CRT; treatment depends on whether disease is mostly localized or widespread and if it is symptomatic or posing a clinical risk to the patient.
Patients who receive chemotherapy alone may receive subsequent RT to the primary and neck or concurrent CRT as clinically indicated.
Radiation Therapy
Intensity-modulated RT (IMRT) is now widely used in head and neck cancers and is the predominant technique used at NCCN Member Institutions. It is useful in reducing long-term toxicity in head and neck cancers and particularly NPC by reducing the dose to ≥1 major salivary glands, temporal lobes, mandible, auditory structures (including the cochlea), and optic structures. IMRT may help preserve the optic pathway in patients with sinonasal malignancies.
For early-stage, high-risk NPC, radiation doses of 66 to 70.2 Gy given with standard fractions are necessary for control of the primary tumor and involved lymph nodes.
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Cite this: Head and Neck Cancers Clinical Practice Guidelines (NCCN, 2018) - Medscape - Jun 07, 2018.
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