AHNS Series: Do you know your guidelines? Principles of treatment for locally advanced or unresectable head and neck squamous cell carcinoma

Abstract

This article is a continuation of the "Do You Know Your Guidelines" series, initiated by the Education committee of the American Head and Neck Society. Treatment guidelines for advanced head and neck squamous cell carcinoma are reviewed here, including the critical roles of radiotherapy, chemotherapy, and the recent application of immunotherapy agents. We will be limiting this discussion to include cancers of the oral cavity, oropharynx, hypopharynx, and larynx. It should be noted that much of the article pertains to human papillomavirus (HPV)-negative oropharyngeal cancer where applicable, as HPV-positive oropharyngeal squamous cell carcinoma carries a different natural history, different prognosis, and now different staging criteria. Additionally, the article will not include information on nasopharyngeal or sinus cancers, as these latter topics are covered in separate "Do you know your guidelines?" installments and these diagnoses carry somewhat different approaches to diagnosis and management that diverge from the focus of this article.

Keywords: National Comprehensive Cancer Network; advanced head and neck cancer; guidelines as topic; head and neck cancer; management.

Figure 1

Treatment Schematic for Recurrent/Persistent Disease. High-risk features: positive surgical margins, extracapsular extension, perineural invasion, lymphovascular invasion. Abbreviation: RT, radiotherapy; PORT, post-operative radiotherapy; POCRT, post-operative chemoradiotherapy; CRT, chemoradiotherapy. Summarized from the NCCN guidelines.