ESMO E-Learning: Multimodular Treatment in Head & Neck Squamous Cell Carcinoma (HNSCC)

Learning Objectives

  • To evaluate the role of induction, definitive concurrent chemotherapy and sequential therapy in locally advanced head and neck Squamous cell carcinoma (HNSCC)
  • To describe organ preservation strategies
  • To discuss the common indications for postoperative chemoradiation
  • To define the role of bioradiotherapy with cetuximab
  • To understand HPV-associated oropharyngeal cancers
Title Duration Content CME Points CME Test
Multimodular Treatment in Head & Neck Squamous Cell Carcinoma (HNSCC) 42 min. 49 slides 1 Take Test
Psyrri Amanda
Amanda Psyrri
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Head and neck Squamous cell carcinoma (HNSCC) arises in the oral cavity, oropharynx, larynx and hypopharynx. Despite the decrease in tobacco consumption and therapeutic advances in this disease, the incidence and cancer-related mortality in Europe and worldwide remain a challenge.

In over three quarters of new cases, HNSCC is diagnosed at a localised or locally advanced stage which has potentially a curable prognosis. However, patients with locally advanced HNSCC often experience relapse. At this moment, clinical staging is not enough to identify patients who will develop relapse and who need tailored treatment.

Definitive treatment involves a multidisciplinary team of surgeons, radiation oncologists and medical oncologists, as well as dentists, nutritionists, among other health care professionals, who are essential to ensure the optimal and timely delivery of treatment and recovery from adverse effects after therapy.

In this E-learning module, the author elaborates in a very didactic way, novelties in topics such as concurrent chemoradiotherapy, induction chemotherapy, sequential therapy, and bioradiotherapy with cetuximab, as a strategy to improve outcomes by utilising EGFR inhibitors. She concludes that cisplatin chemoradiotherapy remains the standard of care for locally advanced HNSCC. Cetuximab is approved with radiation for locally-advanced HNSCC, but no prospective comparison with cisplatin-radiotherapy has been performed. The TPF regimen is the preferred induction regimen. Sequential therapy is not superior to chemoradiotherapy alone.

Patients with HPV-associated tumours, especially those who are non-smokers, have generally excellent outcome as their tumours are highly sensitive to both chemotherapy and radiation, whereas those with tobacco-related and HPV-negative tumours, who continue to represent substantial number of cases in Europe, have worse prognosis due to tumours that are more resistant to treatment.

Patients with HPV-associated oropharyngeal carcinoma are younger and expected to live long; therefore, morbidity resulting from late toxicity is a concern in these patients. Deintensification trials for HPV-associated oropharyngeal cancers are ongoing.

At the end of the module, the author elaborates the surgical management of the neck. In particular, she recommends always neck dissection in patients who have any clinically apparent residual disease after chemoradiotherapy. If surgical salvage is necessary for the primary tumour, a neck dissection may be required to access the primary or for donor vessels for free flap reconstruction. Observation is acceptable if no lymph node or lymph node <1 cm is present at CT/MRI and in case of negative PET/CT after chemoradiotherapy.

Last update: 04 March 2016

The author has reported to have participated in advisory boards of Merck Serono, MSD and AstraZeneca.