Head and Neck Cancers Clinical Practice Guidelines (NCCN, 2018)

National Comprehensive Cancer Network

Reviewed and summarized by Medscape editors

June 07, 2018

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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