Pan-Asian adaptation of the EHNS-ESMO-ESTRO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with squamous cell carcinoma of the head and neck

Abstract

The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of squamous cell carcinoma (SCC) of the oral cavity, larynx, oropharynx and hypopharynx was published in 2020. It was therefore decided by both the ESMO and the Korean Society of Medical Oncology (KSMO) to convene a special, virtual guidelines meeting in July 2021 to adapt the ESMO 2020 guidelines to consider the potential ethnic differences associated with the treatment of SCCs of the head and neck (SCCHN) in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with SCCHN (excluding nasopharyngeal carcinomas) representing the oncological societies of Korea (KSMO), China (CSCO), India (ISMPO), Japan (JSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter was discussed when appropriate. This manuscript provides a series of expert recommendations (Clinical Practice Guidelines) which can be used to provide guidance to health care providers and clinicians for the optimisation of the diagnosis, treatment and management of patients with SCC of the oral cavity, larynx, oropharynx and hypopharynx across Asia.

Keywords: ESMO; Pan-Asian; guidelines; head and neck; squamous cell carcinoma; treatment.

Figure 1

Management of oral cavity cancer (stage I-IVB), excluding lip carcinoma. BSC, best supportive care; c, clinical; ChT, chemotherapy; CRT, chemoradiotherapy; DOI, depth of invasion; M, metastasis; N, node; RT, radiotherapy; T, tumour. ^a If DOI <10 mm: sentinel lymph node biopsy is a valid option; if DOI <5 mm and cT1N0, active surveillance of the neck is a valid option.

Figure 2

Management of laryngeal cancer (stage I−IVB). BSC, best supportive care; c, clinical; ChT, chemotherapy; CRT, chemoradiotherapy; M, metastasis; N, node; RT, radiotherapy; T, tumour. ^a Not requiring total laryngectomy. ^b Requiring total laryngectomy. ^c cT1−2N0 glottic cancer does not require neck dissection or neck RT. ^d Altered fractionation (accelerated or hyperfractionated) RT is a valid option for selected T3 or T3N1.

Figure 3

Management of oropharyngeal cancer (p16-negative stage I−IVB; p16-positive stage I−III). c, clinical; CRT, chemoradiotherapy; M, metastasis; N, node; RT, radiotherapy; T, tumour. ^a Altered fractionation (accelerated or hyperfractionated) RT is a valid option for T1−N1, T2−N0 or T2−N1. ^b Altered fractionation (accelerated or hyperfractionated) RT is a valid option for T1−N1 or T2−N1. ^cAltered fractionation (accelerated or hyperfractionated) RT is a valid option for T1−N1 or T2−N1.

Figure 4

Management of hypopharyngeal cancer (stage I−IVB). BSC, best supportive care; c, clinical; ChT, chemotherapy; CRT, chemoradiotherapy; M, metastasis; N, node; RT, radiotherapy; T, tumour. ^aIn the case of patients unfit for curative treatment. However, curative treatment should be considered for most patients.

Figure 5

Management of recurrent and/or metastatic disease not amenable to curative RT or surgery. BSC, best supportive care; c, clinical; ChT, chemotherapy; CRT, chemoradiotherapy; 5-FU, 5-fluorouracil; M, metastasis; MCBS, Magnitude of Clinical Benefit Scale; N, node; PCE, paclitaxel, carboplatin and cetuximab; PD-L1, programmed death-ligand 1; RT, radiotherapy; T, tumour; TPeX, cisplatin/docetaxel/cetuximab.