Medical Oncology

Head and Neck Cancers   

Questions discussed in this category



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...

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...

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

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...

Even though we do not have the best data on the use of induction chemotherapy, what are current practices?


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

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

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

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

The Lancet. Oncology, 2017-09

J Natl Compr Canc Netw,

Future Oncol, 2016 Aug 23

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,