Medical Oncology

Head and Neck Cancers   

Questions discussed in this category



This would apply to gynecologic and GI cancers as well. And as long as the patient's partner is within the recommend age of <45 yo

Severe lymphopenia can develop during treatment and increase the risk of Candida/HSV superinfection, along with potential challenges for any procedure...

How do the results affect your recommendations for workup and management?

What clinical or radiographic factors would lean you in either direction - ie. time since index diagnosis, distribution or appearance of lung and noda...

For example, initial imaging shows numerous bilateral nodal mets extending into the low neck but after induction gem/cis, originally involved nodes ar...

There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?

Please specify how your institution is allocating resources now or will be soon.

Are you waiting until drug availability or changing to a preferred non-cisplatin radiosensitizer? If you're utilizing an alternative to cisplatin, wha...

Is there data on efficacy or toxicity when chemotherapy is added to Proton beam therapy for head and neck cancer like there is data to support adding ...

According to the NCCN guidelines, there is a highly selected group of T4a glottic larynx patients that can undergo observation instead of postoperativ...

Encouraging aggressive PO intake in patients with swallowing dysfunction may place them at risk for aspiration pneumonia, especially risky if undergoi...

In light of recent trials showing no difference in outcomes with RT+cetuximab vs RT+IO, does this potentially lead us to use immunotherapy in cisplati...

There have been reports of pembrolizumab leading to lichen planus (my understanding is lichen planus pathophysiology unclear, but potentially autoimmu...

If so, do you use it for all patients or only cisplatin doses >= 70 mg/m2? What dose of mannitol do you use?

What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice...

Resected small bilateral tonsil SCC & base of tongue SCC. The patient received 6 cycles of BEP 30 years ago for testicular cancer, and suffers fr...

Has your practice changed based on the randomized, phase 3 study showing prophylactic gabapentin is not effective? Please share your thoughts and exp...

What clinical criteria would make you prefer TORS as the initial treatment approach?  

How do you stage? Like nasopharynx or p16+ oropharynx? Do you treat it like npx ca with chemo xrt + adj chemo or like opx p16+ with definitive chemo ...

Lymph node is 4.5cm with no reported ECE. Does the size of the LN or presence or absence of ECE affect your decision?

Would you prioritize the head and neck cancer or treat the lung cancer first with SBRT to take care of it first? How about if there is mediastinal inv...

Is there any role of radiation therapy for these patient for symptomatic relief? 

Would you consider induction: TPF vs cis/gem or would you proceed with chemoradiation with cis/RT and consider adjuvant cis/5FU?

If so, how do you sequence it? Would you consider before adjuvant radiation vs concurrent with adjuvant (chemo)radiation vs after adjuvant radiation? ...

In the post-op setting, would you delay 1 week even if it took them out of the 6 weeks post-op window? Meaning the loading dose of erbitux was given d...

If advanced stage do you follow same guidelines as Scc? Do you use same Cth regimen? Role of total laryngectomy ? 

Would gross ENE or R1 resection trigger you to consider adding chemo? If so, do you use weekly cisplatin or cisplatin/etoposide?

Are you employing more or less primary chemoRT v. surgery for some cancers? Are you dose de-escalating? What are issues radiation oncologists should b...

Would you consider it for a patient with good PS but with limited metastatic disease? What dose fractionation would you prefer?

How do you decide on other chemo regimen? (Dosing, frequency, carboplatin based, non-platinum based etc.) Would you use Cetuximab? Altered fractiona...

Is there data to support every 3 week dosage v. weekly? https://ascopost.com/news/march-2022/postoperative-weekly-vs-every-3-week-cisplatin-i...

Does the availability of first line checkpoint inhibitor therapy affect your treatment decision? 

Do different modalities of imaging (PET vs MRI vs CT) help you to distinguish one etiology versus the others? What about other clinical characteristic...

Aside from smoking cessation, what interventions have you found useful to manage patients with chronic symptomatic laryngeal edema? Steroids seem to b...

How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...

For example, for a patient that has been through multiple disfiguring surgeries and radiation and wants to delay time to next resection.

Specifically with reference to rural settings where the logistics of early in the week delivery may be more challenging.

-The data on induction for adult H&N ca has been mixed (excluded NPX) but recent data suggest a benefit for adult NPX. -Given that this is standa...

Patient initially was started on cetuximab due to renal insufficiency of unclear chronicity (uncontrolled hypertension) that significantly improved du...

Although platinum/5-FU was used in KEYNOTE-048, can an alternative like carbo/paclitaxel be given since it may be better tolerated?

Given not surgical candidate and within 1 year of chemoRT (recurrence within RT field), would you repeat chemoRT, RT alone, or systemic therapy alone?...

Some ENTs advocate for a neck dissection as a way to avoid chemotherapy if there is a high chance there is no ECE. This is without removing the primar...

Would you proceed with induction chemotherapy (eg TPF or cis/gem) to downstage or neoadjuvant chemoRT? Would your approach be different if there is or...

Have you seen RAI or lenvatinib be efficacious for locally advanced disease — allowing for better surgical outcomes?  Do you utilize EBRT?

Do you have a time threshold for re-challenge with platinum?  Of note, Checkmate 141 defined platinum refractory as relapse within 6 months of pl...

For the first treatment day (during combined chemo/XRT courses), is it ok to give XRT first then send the patient for chemo or should the chemo be giv...

Do you ever start radiation +/- 24-48 hrs from C1D1 for chemotherapy due to logistical barriers? Do you prefer chemotherapy to start at beginning of ...

Is concurrent chemotherapy necessary for these patients?

Does papillary histology influence your decisions regarding surgery, chemo, radiation dose or nodal coverage?

Routinely? Only with oropharyngeal cancer etc.? Given that low expression of EGFR subset did better, do you believe there is a true benefit in cetuxim...

Would you offer locoregional control alone, locoregional with adjuvant therapy, or active surveillance?

Which of the systemic options would you give concurrently with radiation therapy in the adjuvant setting? According to NCCN guidelines, high dose...

In the context of the new staging systems and possible differences of HPV mediated vs smoking mediated oropharynx SCC, would you ever not recommend co...

If not, what is your thyroid hormone withdrawal protocol?  If so, would you still treat a patient with possibly metastatic disease?  

Do you typically use 5-FU/cisplatin/cetuximab, or do you prefer other options?

If so, when? Although anemia is associated with worse local control in HN cancer, I don't know of any data that shows that blood transfusions can help...

If a patient had a recurrence that was pathologically proven despite negative idodine scans, what imaging scans would you follow up with for surveilla...

Even though we do not have the best data on the use of induction chemotherapy, what are current practices? Is your practice different between HPV+ an...


Papers discussed in this category


Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-03-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-09-01

The Lancet. Oncology, 2013-03

Cancer, 2004-03-15

Mayo Clinic proceedings, 2012-03

Oral oncology, 2016-09

Cancer, 2002-06-01

The Lancet. Oncology, 2010-01

Oral oncology, 2014-05

Head & neck, 2015-03

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-04-20

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2003-01-01

Cancer, 2010-10-01

Head & neck, 2016-04

Cancer, 1990-11-01

Ann. Oncol., 2010 Apr 28

J Clin Oncol, 2017 Dec 8

Radiother Oncol, 2011-01-01

Acta Oncol, 2011-10-01

Int J Radiat Oncol Biol Phys,

Laryngoscope, 2016 Jun 12

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2003-01-15

N. Engl. J. Med., 2008-09-11

JAMA otolaryngology-- head & neck surgery, 2016-11-01

Pain practice : the official journal of World Institute of Pain, 2017-11

Med Phys, 2013-08-01

Int. J. Radiat. Oncol. Biol. Phys., 2009-01-01

N. Engl. J. Med., 2012-05-03

N. Engl. J. Med., 2012-05-03

Cancer journal (Sudbury, Mass.), 2017

Head & neck, 2014-01

Otolaryngol Head Neck Surg, 1994 Feb

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-04-20

Cancer,

Head Neck, 2019 Feb 01

The New England journal of medicine, 2018-02-22

Lancet, 2018 Nov 15

International journal of radiation oncology, biology, physics, 1994-06-15

International journal of radiation oncology, biology, physics, 2010-12-01

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2010-06

Lung cancer (Amsterdam, Netherlands), 2021 Jan 30

Int J Radiat Oncol Biol Phys,

N. Engl. J. Med., 2019 May 31

The New England journal of medicine, 2015-02-12

Oral oncology, 2017-06

The New England journal of medicine, 2018-11-22

J. Clin. Oncol., 2019 Sep 25

J Pharm Sci,

J. Clin. Oncol.,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-06-20

Int. J. Radiat. Oncol. Biol. Phys.,

Lancet, 2019 Nov 01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-12-01

The Lancet. Oncology, 2017-09

J Natl Compr Canc Netw,

Future Oncol, 2016 Aug 23

Radiother Oncol, 2009 May 14

The New England journal of medicine, 2006-02-09

Lancet (London, England), 2019-01-05

J. Natl. Cancer Inst.,

Lancet Oncol., 2017 May 09

Cancer discovery, 2015-07

J Immunother Cancer,

J Clin Oncol, 2021 Apr 26

Eur J Cancer, 2019 Feb 13

Laryngoscope, 2014 Jul

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2016-12

Head Neck,

The New England journal of medicine, 2007-10-25

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1998-04

N Engl J Med,

Int. J. Radiat. Oncol. Biol. Phys., 2011 Jun 15

Cancer, 2004-12-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-05-10

The Lancet. Oncology, 2016-07

N Engl J Med, 2016 Oct 08

Int J Radiat Oncol Biol Phys, 2021 Nov 20

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-07-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010-06-01

Head & neck, 2014-05

Lancet Oncol, 2020 Aug 03

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010-03-10

Cancer chemotherapy and pharmacology, 2003-07

J Oncol Pharm Pract, 2009 Sep 16

Cancer Treat Rep,

Ann Pharmacother, 2012 Jan 31

Lancet, 2021 Jun 07

International journal of radiation oncology, biology, physics, 2014-03-01

N Engl J Med, 2020 Sep 18

BMC Cancer, 2021 May 27

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-08-10

Clinical cancer research : an official journal of the American Association for Cancer Research, 2020 Sep 09

Medicine (Baltimore), 2019 Dec

J Clin Invest, 2013 Nov 15

Nat Commun, 2022 Nov 16

JAMA Otolaryngol Head Neck Surg, 2022 Dec 22

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2004-07-15

International journal of radiation oncology, biology, physics, 2000-04-01

Lancet Oncol., 2012-02-01

J Clin Oncol, 2004 Jan 1

The Laryngoscope, 2017-10

In Vivo, 2022 Mar-Apr

J Clin Oncol, 2023 Jan 27

Eur J Cancer, 2007 Apr 27

J Clin Oncol, 2018 Jun 07

Journal of the National Cancer Institute, 2016-06

Pediatrics, 2014 Feb 02

N. Engl. J. Med.,

The Journal of urology, 2018-12

N. Engl. J. Med.,

Lancet Oncol., 2014 Feb 18

NEJM Evidence, 2022 Jun 1

Br J Cancer, 2014 Apr 15

Cancer, 2011-06-15

Eur J Cancer, 2017 Nov 28

N. Engl. J. Med., 2019 Sep 28

Lancet Oncol, 2021 Jan 18

J Clin Oncol, 2021 Apr 19

J Clin Oncol, 2003 Jul 01

JAMA, 2019 Apr 16

Head Neck, 2016 Mar 29

The Lancet. Oncology, 2017-05

Adv Radiat Oncol, 2022 May 18

Oral Oncol, 2022 May 27

Radiother Oncol, 2017 Aug 29

Lancet Oncol,

J Clin Oncol, 2021 Oct 26

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2020 Feb 04

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2021 Jan 27

Annals of oncology : official journal of the European Society for Medical Oncology, 2013 Nov 19

Journal of the National Cancer Institute, 2009 Jan 27

Journal of the National Cancer Institute, 2009 Mar 24

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2013-11

Cancer, 2002-11-15

Journal of experimental therapeutics & oncology, 1996-03

Indian J Palliat Care, 2009 Jul

La Radiologia medica, 1996 Apr

QJM : monthly journal of the Association of Physicians, 2020 Jan 01

Integrative cancer therapies, 2021 Jan-Dec

Indian journal of dental research : official publication of Indian Society for Dental Research, 2020 Sep-Oct

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2021 Jul 31

Evidence-based complementary and alternative medicine : eCAM, 2022 Apr 19

The Journal of laryngology and otology, 2008 May 19

The journal of contemporary dental practice, 2008 Mar 01

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2020 Sep 05

International journal of radiation oncology, biology, physics, 2005 Oct 24

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2023 Sep 01

The American journal of surgical pathology, 2017-04

World journal of clinical cases, 2023 Nov 16

Clinical cancer research : an official journal of the American Association for Cancer Research, 2020 Jul 14

Oral oncology, 2013 Jan 29