Multimodular treatment in Head and Neck Squamous Cell Carcinoma (HNSCC)
|
|
- Phyllis Reynolds
- 5 years ago
- Views:
Transcription
1 Multimodular treatment in Head and Neck Squamous Cell Carcinoma (HNSCC) Amanda Psyrri, MD,FACP Attikon University Hospital Athens, Greece
2 Learning objectives After reading and reviewing this material, the participant should be able to: Evaluate the role of induction, definitive concurrent chemotherapy and sequential therapy in locally advanced HNSCC Describe organ preservation strategies Discuss the common indications for postoperative chemoradiation Define the role of bioradiotherapy with cetuximab Understand HPV-associated oropharyngeal cancers
3 Outline Introduction Concurrent chemoradiotherapy Induction chemotherapy Sequential therapy Bioradiotherapy with cetuximab HPV-associated oropharyngeal cancers Surgical management of the neck
4 Many subsites Heterogeneous group of tumours of varying primary sites 95% are HNSCC Oral cavity Oropharynx/hypopharynx Larynx Nasopharynx Other anatomic sites Paranasal sinuses Salivary glands Lip Image courtesy of Massachusetts General Hospital Cancer Center
5 Etiology Traditionally, tobacco and alcohol use account for the majority of HNSCC A growing proportion of oropharyngeal squamous cell carcinomas is caused by high-risk Human Papillomaviruses (HPV), especially HPV16
6 Incidence in the USA In 2015, 45,780 new cases of oral cavity and pharynx cancer and 8,650 deaths are expected to occur in the United States Oral cavity and pharynx Stage distribution by race United States year relative survival rates by race and stage United States All races White Black Localised Regional Distant 0 Localised Regional Distant All stages Redrawn from Siegel MPH, et al. CA Cancer J Clin 2015;65:5 29
7 Incidence and Mortality Worldwide WHO Europe region (adults) 15 th most common cancer in Europe 1 Estimated numbers (x100) Lip and oral cavity cancer in Europe (2012): 61,400 new cases diagnosed (2% total) ~34,100 cases of other pharyngeal cancer diagnosed (1% total cancer cases) 1 Highest World age-standardised incidence rates in Hungary (both men and women); lowest rates in Greece for men and Cyprus for women Worldwide (2012): >142,000 cases of other pharyngeal cancer diagnosed (1% total cancer cases) Lip and oral cavity cancer incidence rates highest in Melanesia and lowest in Western Africa, partly reflecting varying data quality worldwide Incidence rates of other pharyngeal cancer highest in Western Europe and lowest in Western Africa 1 1. Ferlay J, et al. GLOBOCAN 2012 v1.0. Available from: accessed December Ferlay J, et al. Eur J Cancer 2013;49:
8 Epidemic of HPV-associated OPC* Incidence rates for overall oropharyngeal cancer, HPV-positive oropharyngeal cancer, and HPV-negative oropharyngeal cancer from 1988 to 2004 in Hawaii, Iowa, and Los Angeles Estimated age-standardised incidence of human papillomavirus (HPV)-positive and HPV-negative tonsillar cancer squamous cell carcinoma cases per 100,000 person-years, Stockholm, Sweden, Chaturvedi AK, et al. J Clin Oncol 2011;29: Reprinted with permission American Society of Clinical Oncology. All rights reserved Error bars indicate 95% CI. Näsman A, et al. Int J Cancer 2009;125: Reproduced with permission from Wiley
9 Staging overview Stage TNM Stage 0 T is N 0 M 0 Stage I T 1 N 0 M 0 Stage II T 2 N 0 M 0 Stage III T 3 N 0, T 1-3 N 1, M 0 Stage IVA T 4a N 0-2,M 0, T 1-3 N 2,M 0 Stage IVB Stage IVC T and N stages vary by anatomic site N2 or T4 tumours locoregionally advanced (Stage IV) Typically T1: 2 cm, T2: 2-4 cm, T3: 4 cm, T4: invades adj. structures N1: single LN 3 cm, N2: LN 2 cm or several LN, N3: >6 cm TNM: tumour nodes metastases Any T, N 3, M 0, T 4b, Any N, M 0 M 1, any T or N Patel SG, et al. CA Cancer J Clin 2005;55;
10 Meta-analysis of chemotherapy in HNC (MACH-NC) 63 randomised trials ( ) n = 10,717 pts with SCC of the oropharynx, oral cavity, larynx, or hypopharynx Comparison of locoregional treatment with and without chemotherapy Median follow-up: 6 years Overall benefit 4% at 5 years (32% vs. 36%) Trials N RR P value Absolute benefit (5 Yrs), % Adjuvant NS 1 Induction NS 2 Concomitant < HNC, head and neck cancer; MACH-NC, meta-analysis of chemotherapy in head and neck cancer; SCC, squamous cell carcinoma; ORR, overall risk reduction; RR, relative risk. Pignon JP, et al. Lancet 2000;355:
11 MACH-NC: An Update 24 added trials 87 studies, 16,485 patients MACH-HN I: 8% absolute benefit concurrent-no significant effect of IC No significant difference (p = 0.19) was seen between mono-chemotherapy (HR 0.84) and poly-chemotherapy (HR 0.78) In the mono-chemotherapy group, the effect of chemotherapy was significantly higher (p = 0.006) with platin than with other types of mono-chemotherapies Age matters Younger than 50 years of age: 24% increased survival Older than 70 years of age: 3% increased survival MACH-NC, meta-analysis of chemotherapy in head and neck cancer; IC: induction chemotherapy Pignon JP, et al. Radiother Oncol 2009;92:4-14
12 Pluses and minuses of chemoradiation Improves locoregional control Facilitates organ preservation Beneficial impact on survival Doubles the rate of severe acute mucositis Use may be excessive based on stage Long-term functional deficits in speech, swallowing, mobility
13 Randomised trials of induction PF ± taxane Study Eligibility N T + PF CR/PR, n/n (%) PF CR/PR, n/n (%) TPF/PF PFS, Mos TPF/PF OS, Mos P Value (HR) Hitt JCO 2005 Stage III-IV /47 (80) 14/54 (68) yrs: 66%/61%.035 (0.67) TAX 323 NEJM 2007 Unresectable 35 8 (68) (54) yrs: 24%/18%.005 (0.71) Gortec ASCO 2006 L/HP II-IV /39 (82) 30/30 (60) LP: 63%/41%.036 TAX 324 NEJM 2007 III-IV /55 (72) 15/49 (64) 2-yr PFS: 53%/42% yrs: 62%/48%.006 (0.7) CR, complete response; HP, hypopharynx; HR, hazard ratio; L, larynx; LP, larynx preservation; OS, overall survival; PF, cisplatin, 5-fluorouracil; PFS, progression-free survival; PR, partial response; T, docetaxel; TPF, docetaxel, cisplatin, 5-fluorouracil.
14 Randomised trials of sequential therapy*: Definitive chemo RT ± induction Trial Eligibility Target N* Control Tx Exp Tx OS DeCIDE U Chicago N DHFX TPF x 2 DHFX NS Paradigm DFCI Stages III-IV Cisplatin CB-RT TPF x 3 Carbo-RT or D-CB-RT NS SWOG Oropharynx 400 Cisplatin RT TPF x 1-3 surgery or cisplatin-rt Carbo, carboplatin; CB, concomitant boost; chemort, chemoradiation therapy; DFCI, Dana-Farber Cancer Institute; RT, radiation therapy; TPF, docetaxel, cisplatin, 5-fluorouracil. DHFX, docetaxel, fluorouracil, and hydroxyurea *All powered to show survival difference of 10% to 15%.
15 EGFR as a molecular target in HNSCC EGFR expression linked to poorer outcome 1 and reduced response to radiotherapy 2,3 Psyrri A, Presented at ASCO 2013 Lecture: EGFR, new data and best use of inhibitors (adapted from 1. Psyrri A, et al. Clin Can Res 2005;11: ; 2. Baumann M, Krause M. Radiother Oncol 2004;72: ; 3.Ang KK, et al. Cancer Res 2002;62:
16 Cetuximab Cetuximab IgG 1 mab Chimeric protein Specifically binds with high affinity to FcγRI (EC50 = 0.13 nm) and FcγRIIIa (EC50 = 6 nm) Induces apoptosis and ADCC* Preclinical synergistic activity in combination with chemotherapy and radiotherapy *ADCC: antibody dependent cellular cytotoxicity EGFR, epidermal growth factor receptor; mab Li S, et al. Cancer Cell 2005;7: Figure courtesy of Psyrri A. Presented at ASCO 2013; adapted from Vermorken JB, MCO 2011; ESO-ESMO Masterclass in Clinical Oncology
17 Phase III Study Design Eligibility Patients with locoregionally advanced squamous cell carcinoma of either the oropharynx, hypopharynx, or larynx Stratified by Karnofsky score: vs Regional nodes: Negative vs. positive Tumour stage: AJCC T1-3 vs. T4 RT fractionation: Concomitant boost vs. once daily vs. twice daily R A N D O M I S E Arm 1 (RT) Radiation therapy Primary endpoints: Overall survival, locoregional control Arm 2 (RT + C) Radiation therapy + cetuximab wkly Bonner JA, et al. N Engl J Med 2006;354:
18 Most common adverse events Toxicity, % RT (n = 212) RT + C (n = 208) All Grades Grades 3/4 All Grades Grades 3/4 Skin reaction Mucositis/stomatitis Dysphagia Xerostomia Fatigue/malaise Infusion reaction* *Listed for its relationship to cetuximab; P < 0.05; P < 0.001, Fisher s exact test. Bonner JA, et al. N Engl J Med 2006;354:
19 Probability of overall survival ERBITUX + RT: Overall survival 5 year update ERBITUX + RT improves significantly long term survival, with nearly half of the patients alive at 5 years ERBITUX + RT RT p-value 5-year OS rate 46% 36% 0.02 ERBITUX + RT HR=0.73 ( ) p = 0.02 RT Months Treatment Total Dead Alive Median Erbitux + RT RT Bonner JA, et al. Lancet Oncol 2010;1: Reprinted from The Lancet, Copyright (2010). With permission from Elsevier
20 RTOG 9111: Larynx Preservation Trial Phase III larynx preservation trial: induction chemotherapy and radiation therapy vs. concomitant chemotherapy and radiation therapy vs. radiation therapy alone S T R A T I F Y Location 1. Glottic 2. Supraglottic T Stage 1. T2 2. T3, fixed cord 3. T3, no cord fixation 4. T4, with base of tongue 1 cm N Stage 1. N0, N1 2. N2, N3 R A N D O M I S E Arm 1: Arm 2: Arm 3: CR, PR x 3 d cycle RT CDDP/5-FU x 2 cycles NR surgery RT Radiation therapy + CDDP Radiation therapy Chemotherapy Arm 1: cisplatin 100 mg/m 2 /5-FU 1 gm/m 2 /24 hrs CVI x 120 o q3wks x 3 Arm 2: cisplatin 100 mg/m 2 Days 1, 22, 43 of RT Forastiere AA, et al. N Engl J Med 2003;349:
21 RTOG 9111: Larynx Preservation Trial The median follow-up among surviving patients, 3.8 years Demographics: median age 59 years; 94% KPS 80; 50% N0; 68% SGL; 28% N2-3 Arm cddp/5-fu RT RT/cDDP RT Enrolled, n (evaluable) 180 (173) 182 (172) 185 (173) 2-yr laryngectomy FS, % yr DMFS, % yr DFS, % yr OS,% Conclusions RT/cDDP: stat signif in LFS (P = 0.01) No SS diff in survival 5-FU, 5-fluorouracil; cddp, cisplatin; DFS, disease-free survival; DMFS, distant metastasis-free survival; FS, free survival; KPS, Karnofsky performance score; LFS, laryngectomy-free survival; OS, overall survival; RT, radiation therapy; SGL, supraglottal larynx; SS, statistically significant. Forastiere AA, et al. N Engl J Med 2003;349:
22 (A) Laryngeal preservation, (B) laryngectomy-free survival, (C) overall survival, and (D) locoregional control according to treatment group; conc., concomitant; ind., induction; RT, radiation therapy P<0.001 P=0.02 P=0.53 P= Forastiere AA, et al. J Clin Oncol 2013;31: Reprinted with permission American Society of Clinical Oncology. All rights reserved
23 Survival, limited to (A) deaths from study cancer and (B) deaths not caused by study cancer according to treatment group; conc., concomitant; ind., induction; RT, radiation therapy P=0.03 Forastiere AA, et al. J Clin Oncol 2013;31: Reprinted with permission American Society of Clinical Oncology. All rights reserved
24 Nonsurgical treatment options for locally advanced HNSCC 5-FU, 5-fluorouracil; CI, confidence interval; HR, hazard ratio; RT, radiation therapy; SCCHN, squamous cell carcinoma of the head and neck; TPF, docetaxel, cisplatin, 5-fluorouracil; Ctx: chemotherapy 1. Pignon JP, et al. Lancet 2000;355: ; 2. Bonner JA, et al. Lancet Oncol 2009;11:21-8; 3. Vermorken JB, et al. N Engl J Med. 2007;357: ; 4. Posner MR, et al. N Engl J Med 2007;357:
25 Adjuvant Trials: HNSCC RT ± CT (DDP) Trial RT (Gy) F/U, mos LRC, % DFS, % OS, % RTOG 9501 [1] 2 LN, ECE, + margins n = 459 (60-66) vs. 70 (P = 0.01) 33 vs. 25 (P = 0.04) 45 vs. 38 (P = 0.19) EORTC [2] N2-3, ECE, + margins n = 350 (66) vs. 69 (P = 0.007) 47 vs. 36 (P = 0.04) 53 vs. 40 (P = 0.002) Bachaud [3] + ECE n = 83 (> 60) vs. 55 (P = 0.05) 45 vs. 23 (P < 0.02) 36 vs. 13 (P < 0.01) DDP, cisplatin; CT, chemotherapy; DFS, disease-free survival; ECE, extracapsular extension; F/U, follow-up; LN, lymph node; LRC, locoregional control; OS, overall survival; RT, radiation therapy; HNSSC, head and neck squamous cell carcinoma 1. Cooper JS, et al. N Engl J Med. 2004;350: ; 2. Bernier J, et al. N Engl J Med. 2004;350: ; 3. Bachaud JM, et al. Int J Radiat Oncol Biol Phys. 1991;20:
26 EORTC versus RTOG eligibility RTOG Stage III-IV OP, Ocw Level 4 or 5 pos. nodes Perineural Disease Vascular Embolisms Margins+ ECE 2+ pos. nodes EORTC Adapted from Bernier J, et al. Head and Neck Volume 27 Issue 5 Oct 2005
27 Refining adjuvant therapy Risk stratification Category Favourable Low Intermediate (ECE-/margin-) High (ECE+/margin+) Standard of care None Gy Gy Gy + cisplatin Separate trials are currently designed for intermediate-risk and high-risk groups Cooper JS, et al. N Engl J Med 2004;350: ; Bernier J, et al. N Engl J Med 2004;350: ; Ang KK, et al. Int J Radiat Oncol Biol Phys 2001;51:
28 Strategies to improve outcomes in HNSCC utilising EGFR inhibitors Treatment intensification of locally advanced HNSCC to improve OS Randomised trials: CRT+EGFR inhibitor versus CRT EGFR inhibition in the post-induction setting to reduce toxicity in sequential design Randomised phase II studies of induction chemotherapy followed by either chemoradiotherapy or cetuximab radiotherapy to reduce toxicity without compromising efficacy CRT: chemoradiotherapy; OS: overall survival
29 Randomised trials of EGFR inhibitor plus chemoradiation in HNSCC Author # pts Treatment Comparator Primary endpoint Setting S vs. E P value Giralt et al C+EBRT+P C+ EBRT 2 yr LRC Locally advanced 68% vs. 61% 0.3 Martins et al C+RT+ Erlotinib C+RT CRR Locally advanced 40% vs. 52% 0.08 Ang et al C+RT+ cetuximab C+RT PFS Locally advanced 64% vs. 63% NS C: cisplatin; EBRT: external beam radiation therapy; RT: radiation therapy; S: standard, E: experimental arm; P: Panitumumab; CRR: complete response rate
30 EGFR inhibitor + chemoradiation: Toxicity Author Mucositis Toxicity Grade 3 Skin reactions Skin reactions out of field E S E S E S Ang 43% 33% 25% 15% 29% 1% Giralt 11% 5% 28% 13% 11% 0% Martins 48% 48% 13% 2% NR NR
31 Strategies to improve outcomes in HNSCC utilising EGFR inhibitors Treatment intensification of locally advanced HNSCC to improve OS Randomised trials: CRT+EGFR inhibitor versus CRT EGFR inhibition in the post-induction setting to reduce toxicity in sequential design Randomised phase II studies of induction chemotherapy followed by either chemoradiotherapy or cetuximab radiotherapy to reduce toxicity without compromising efficacy CRT: chemoradiotherapy; OS: overall survival
32 The randomised Phase II Study: TREMPLIN Previously untreated SCC larynx/hypopharynx suitable for TL Primary endpoint: Larynx preservation 3 months after treatment Secondary endpoints: Larynx function preservation and survival 18 months after treatment PR 116 TPF (153 patients) 3 cycles, 1 cycle q3w T = 75 mg/m² on day 1 P = 75 mg/m² on day 1 F = 750 mg/m² on day 1 to 5 < PR 23 R Total laryngectomy + post-op RT 60 patients: RT 70 Gy Cisplatin 100 mg/m² on days 1, 22 and patients: RT 70 Gy ERBITUX 400 mg/m² 1 wk prior to RT then 250 mg/m² weekly on wks 1 to 7 P: cisplatin; F: 5-fluorouracil; T: docetaxel; TL: total laryngectomy; PR: partial response ; RT: radiotherapy; CT: computed tomography; Tx: treatment Lefebvre JL, et al. J Clin Oncol 2013;31:
33 Acute toxicity during RT Grade 3 mucositis Grade 4 mucositis Grade 3 in field skin toxicity Grade 4 in field skin toxicity Other toxicities, any grade, justifying a protocol modification Renal toxicity Hematological toxicity Poor general condition Infusion-related reaction Protocol modification due to acute toxicity Cisplatin n = (43%) 2 14 (24%) 1 9 (15.5%) 8 (14.0%) 7 (12.0%) 0 ERBITUX n = (43%) 1 29 (52%) (1.7%) 3 (5.0%) p-value NS < (57%) 19 (29%) 0.02 *2 patients did not start the treatment in the cisplatin arm Lefebvre JL, et al. J Clin Oncol 2013;31:
34 Carcinologic events (ITT) Total of local (+/- regional) failures Feasible salvage total laryngectomy Successful salvage total laryngectomy At 18 months after end of treatment Last evaluation with a median follow-up of 36 months Cisplatin ERBITUX p-value Cisplatin ERBITUX p-value 5 (8.3%) 8 (14.3%) Log-rank: (11.7%) 0/4* 7/ /6* 12 (21.4%) 9/12 (1 refused) 0/1 7/8 Log-rank: 0.14 Ultimate local failure rate 6 (10%)* 5 (8.9%) NS Regional failure alone 5 (8.3%) 5 (8.9%) NS 5 (8.3%) 5 (8.9%) NS Distant metastases 2 (3.3%) 2 (3.6%) NS Second primary tumour 3 (5.0%) 3 (5.3%) NS 0.04 *Data missing for 1 patient lost to follow-up at 5 months ITT: intention to treat Lefebvre JL, et al. J Clin Oncol 2013;31:
35 Endpoints (ITT) Primary endpoint (3 months after end of Tx) Larynx preservation, n (%) (larynx in place without tumour) Cisplatin n = 60 ERBITUX n = 56 p-value 57 (95%) 52 (93%) 0.63 Secondary endpoints (18 months after end of Tx) Larynx function preservation, n (%) (larynx in place without tumour/trach/feeding tube) NB: At 18 months or at death Overall survival NB: Since randomisation Cisplatin n = 60 ERBITUX n = 56 p-value 52 (87%) 46 (82%) % 89 % Log-rank: 0.44 NB: 1 pt lost to FU in the Cisplatin arm is considered as failure Lefebvre JL, et al. J Clin Oncol 2013;31:
36 With permission of Maria Ghi, et al. ASCO 2012, abstract 5513 A phase II/III study comparing CRT to cetuximab/rt with or without induction TPF in locally advanced HNSCC
37 Skin rash any grade Grade 3-4 Nausea any grade Grade 3-4 Vomiting any grade Grade 3-4 Renal any grade Grade 3-4 Neurological any grade Grade 3-4 Neutropenia Grade 3-4 CT/RT (n=215)% RT/cetuximab (n=133)% p value <0.01 <0.01 < Febrile neutropenia Mucositis any grade Grade 3 Grade 4 In-field skin toxicity any grade Grade 3 Grade 4 Maria Ghi, et al. ASCO 2012, abstract
38 Oropharyngeal cancer disease variants: tobacco-related, HPV-related and mixed HPV+,p16+ p16- Weinberger PM, et al. J Clin Oncol 2006;24: Reprinted with permission American Society of Clinical Oncology. All rights reserved Forastiere A, et al. N Engl J Med 2001;345: ; Koontongkaew S. J Cancer 2013;4: Available from CC BY-NC-ND 3.0
39 HPV and survival The relative survival for HPV positive patient is independent of therapy as long as this therapy is within the current standard of care Risk of death is consistently less than 60% that of HPV negative cancers across studies The absolute survival difference is consistently higher than 30%
40 Oropharynx: Classification of patients into risk-of-death categories Oropharyngeal cancer (n=266) HPV-positive (n=178) HPV-negative (n=88) 10 pack-years (n=88) >10 pack-years (n=90) 10 pack-years (n=23) >10 pack-years (n=65) N0-N2a (n=26) N2b-N3 (n=64) T2-T3 (n=15) T4 (n=8) 42.9% at low risk 3 year OS = 93.0% 29.7% at intermediate risk 3 year OS = 70.8% 27.4% at high risk 3 year OS = 46.2% Adapted from: Ang KK, et al. N Engl J Med 2010;363:24 35
41 OS by UICC/AJCC TNM Stage (7th edition) Huang SH, et al. J Clin Oncol 2015;33: Reprinted with permission American Society of Clinical Oncology. All rights reserved
42 Prognostic Grouping Model of HPV(+) OPC M1 disease considered Group IVB Too few cases to analyse; policies too varied Huang SH, et al. J Clin Oncol 2015;33: Reprinted with permission American Society of Clinical Oncology. All rights reserved.
43 Treatment deintensification Aims to reduce treatment-related morbidity and improve patient quality of life without compromising treatment effectiveness Patients with HPV+ OPSCC are younger and expected to live long; therefore, morbidity resulting from late toxicity is a concern in these patients Deintensification strategies include: administering radiotherapy alone, reducing the dose of radiotherapy and substituting chemotherapy with cetuximab
44 Radiation therapy oncology group 1016 : Study Design Stage III/IV Oropharynx p16+ R A N D O M I S E II: Accelerated IMRT 70 Gy/6 weeks (cetuximabx8) I: Accelerated IMRT 70 Gy/6 weeks (cisplatin 100 mg/m², d1, 22) Stratification factors: cn-stage (cn0-2a vs. cn2b- cn3), ct-stage (T1-2 vs.t3-4) Zuprod Performance Status (0 vs. 1), smoking history (<10py vs. >10py) Cmelak A, et al. ASCO 2014
45 ECOG 1308: Phase II Schema Eligibility OPSCC resectable HPV ISH + and / or p16+ Stage III, IVA Induction chemotherapy Cisplatin 75/m 2 d1 Paclitaxel 90/m 2 d1, 8, 15 Cetuximab 250/m 2 d1, 8, 15 Q 21 days for 3 cycles R E S P O N S E E V A L U A T I O N Concurrent chemoradiation CLINICAL CR Low dose IMRT 54 Gy / 27 fx* + Cetuximab qweek CLINICAL PR/SD Full dose IMRT 69.3 Gy / 33 fx* + Cetuximab qweek IMRT margins for primary: 1.0 to 1.5 cm around gross disease Nodal margin: 1 cm margin minimum, treat entire nodal level Primary Objective: 2-year PFS after low-dose IMRT (stat aim: 2-year 85% or better) IMRT: intensity modulated radiation therapy Cmelak A, et al. ASCO 2014
46 Endpoint: 2yr PFS and OS Cohort (n) 2 year PFS (90% CI) 2 year OS (90% CI) All low dose pts (62) 0.80 (0.70, 0.88) 0.93 (0.85, 0.97) T4a (7) 0.54 (0.19, 0.79) 0.86 (0.45, 0.97) Non-T4a (55) 0.84 (0.73, 0.91) 0.94 (0.86, 0.98) N2c (19) 0.77 (0.56, 0.89) 0.95 (0.76, 0.99) Non-N2c (43) 0.82 (0.69, 0.90) 0.93 (0.82, 0.97) Smoker >10 pk-yrs (22) 0.57 (0.35, 0.73) 0.86 (0.67, 0.94) Smoker 10 pk-yrs (40) 0.92 (0.81, 0.97) 0.97 (0.87, 0.995) Smoker 10 pk-yrs, <T4, N2c (27) 0.96 (0.82, 0.99) 0.96 (0.82, 0.99) All high-dose pts (15)* 0.65 (0.41, 0.82) 0.87 ( ) *3 high-dose pts did not go on to receive RT Cmelak A, et al. ASCO 2014
47 Neck dissection Always: 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 at CT/MRI and negative PET/CT after chemoradiotherapy
48 Conclusions Cisplatin chemoradiotherapy remains the standard of care for locally advanced (LA) HNSCC Cetuximab is approved with radiation for LA-HNSCC but no prospective comparison with cisplatin-rt has been performed TPF is the preferred induction regimen Sequential therapy is not superior to chemoradiotherapy alone HPV-positive patients constitute a separate prognostic and therapeutic cohort Deintensification trials for HPV-associated oropharyngeal cancers are ongoing
49 Thank you!
Locally advanced head and neck cancer
Locally advanced head and neck cancer Radiation Oncology Perspective Petek Erpolat, MD Gazi University, Turkey Definition and Management of LAHNC Stage III or IV cancers generally include larger primary
More informationAdjuvant Therapy in Locally Advanced Head and Neck Cancer. Ezra EW Cohen University of Chicago. Financial Support
Adjuvant Therapy in Locally Advanced Head and Neck Cancer Ezra EW Cohen University of Chicago Financial Support This program is made possible by an educational grant from Eli Lilly Oncology, who had no
More informationThe International Federation of Head and Neck Oncologic Societies. Current Concepts in Head and Neck Surgery and Oncology
The International Federation of Head and Neck Oncologic Societies Current Concepts in Head and Neck Surgery and Oncology www.ifhnos.net The International Federation of Head and Neck Oncologic Societies
More informationSequencing Chemo with Radiation therapy Locally Advanced Head and Neck Cancer. Dr P Vijay Anand Reddy Director Apollo Cancer Hospital
Sequencing Chemo with Radiation therapy Locally Advanced Head and Neck Cancer Dr P Vijay Anand Reddy Director Apollo Cancer Hospital H&N Ca - Disease Burden 15-20% of all cancers in India, 8% worldwide
More informationDe-Escalate Trial for the Head and neck NSSG. Dr Eleanor Aynsley Consultant Clinical Oncologist
De-Escalate Trial for the Head and neck NSSG Dr Eleanor Aynsley Consultant Clinical Oncologist 3 HPV+ H&N A distinct disease entity Leemans et al., Nature Reviews, 2011 4 Good news Improved response to
More informationHPV INDUCED OROPHARYNGEAL CARCINOMA radiation-oncologist point of view. Prof. dr. Sandra Nuyts Dep. Radiation-Oncology UH Leuven Belgium
HPV INDUCED OROPHARYNGEAL CARCINOMA radiation-oncologist point of view Prof. dr. Sandra Nuyts Dep. Radiation-Oncology UH Leuven Belgium DISCLOSURE OF INTEREST Nothing to declare HEAD AND NECK CANCER -HPV
More informationThe PARADIGM Study: A Phase III Study Comparing Sequential Therapy (ST) to Concurrent Chemoradiotherapy (CRT) in Locally Advanced Head and Neck Cancer
The PARADIGM Study: A Phase III Study Comparing Sequential Therapy (ST) to Concurrent Chemoradiotherapy (CRT) in Locally Advanced Head and Neck Cancer Robert I. Haddad, Guilherme Rabinowits, Roy B. Tishler,
More informationState of the art for radiotherapy of SCCHN
State of the art for radiotherapy of SCCHN Less side effects Cured More organ & function preservation Head & neck cancer = 42 000 new cases / year in Europe Not cured Local failure Distant failure More
More informationHead and NeckCancer: multi-modal therapeuticintegration
Head and NeckCancer: multi-modal therapeuticintegration P. Ponticelli, L. Lastrucci, R. De Majo, A. Rampini U.O.C. Radioterapia Ospedale S. Donato ASL 8 -AREZZO Summary Biological considerations Clinical
More informationHead and Neck cancer
Head and Neck cancer Medical Oncologist s Role in Multidisciplinary Teams - Focus on Adjuvant & Neo-adjuvant Therapy - Hye Ryun Kim, M.D. Yonsei Cancer Center, Medical Oncology Contents I. Introduction
More informationOrgan-Preservation Strategies in head and neck cancer. Teresa Bonfill Abella Oncologia Mèdica Parc Taulí Sabadell. Hospital Universitari
Organ-Preservation Strategies in head and neck cancer Teresa Bonfill Abella Oncologia Mèdica Parc Taulí Sabadell. Hospital Universitari Larynx Hypopharynx The goal of treatment is to achieve larynx preservation
More informationLaryngeal and hypopharyngeal cancers
Laryngeal and hypopharyngeal cancers Induction Chemotherapy in combined modality approaches Atenas 16.09.2017 Ana Ferreira Castro, MD Medical Oncology Centro Hospitalar do Porto Instituto de Ciências Biomédicas
More informationNeoplasie del laringe Diagnosi e trattamento
Neoplasie del laringe Diagnosi e trattamento Venerdì 22 maggio 2015 Alessandria Trattamenti non chirurgici: Preservazione d organo, malattia localmente avanzata Marco C Merlano A.O. S.Croce e Carle, Ospedale
More informationSAMO MASTERCLASS HEAD & NECK CANCER. Nicolas Mach, PD Geneva University Hospital
SAMO MASTERCLASS HEAD & NECK CANCER Nicolas Mach, PD Geneva University Hospital Epidemiology Prevention Best treatment for localized disease Best treatment for relapsed or metastatic disease Introduction
More informationLaryngeal Preservation Using Radiation Therapy. Chemotherapy and Organ Preservation
1 Laryngeal Preservation Using Radiation Therapy 1903: Schepegrell was the first to perform radiation therapy for the treatment of laryngeal cancer Conventional external beam radiation produced disappointing
More informationPre- Versus Post-operative Radiotherapy
Postoperative Radiation and Chemoradiation: Indications and Optimization of Practice Dislosures Clinical trial support from Genentech Inc. Sue S. Yom, MD, PhD Associate Professor UCSF Radiation Oncology
More informationState of the Art: Management of Squamous Cell Carcinoma of the Head and Neck. Raul Giglio
State of the Art: Management of Squamous Cell Carcinoma of the Head and Neck Raul Giglio Disclosures Nothing to disclose SCCHN Outline 1. General considerations: MTD 2. Epidemiology 3. Locoregional disease
More informationEmerging Role of Immunotherapy in Head and Neck Cancer
Emerging Role of Immunotherapy in Head and Neck Cancer Jared Weiss, MD Associate Professor of Medicine and Section Chief of Thoracic and Head/Neck Oncology UNC Lineberger Comprehensive Cancer Center Copyright
More informationRecent Advances & Ongoing Challenges in Head & Neck Cancers
Recent Advances & Ongoing Challenges in Head & Neck Cancers Robert Haddad, MD Disease Center Leader Head and Neck Oncology Program Dana Farber Cancer Institute Harvard Medical School Boston, MA Disclosures
More informationHead and Neck Cancer:
Head and Neck Cancer: Robert Haddad M.D. Clinical Director Head and Neck Oncology Program Dana Farber Cancer Institute Boston, MA Predictive Biomarkers: HPV Abstract 6003: Survival Outcomes By HPV Status
More informationSimultaneous Integrated Boost or Sequential Boost in the Setting of Standard Dose or Dose De-escalation for HPV- Associated Oropharyngeal Cancer
Simultaneous Integrated Boost or Sequential Boost in the Setting of Standard Dose or Dose De-escalation for HPV- Associated Oropharyngeal Cancer Dawn Gintz, CMD, RTT Dosimetry Coordinator of Research and
More informationHead and Neck Reirradiation: Perils and Practice
Head and Neck Reirradiation: Perils and Practice David J. Sher, MD, MPH Department of Radiation Oncology Dana-Farber Cancer Institute/ Brigham and Women s Hospital Conflicts of Interest No conflicts of
More informationNeoadjuvant Chemotherapy in Locally Advanced Squamous Cell Cancer of Head and Neck. Mei Tang, MD
Neoadjuvant Chemotherapy in Locally Advanced Squamous Cell Cancer of Head and Neck Mei Tang, MD Head and Neck Cancer Worldwide New cases : 644,000 Cancer deaths: 350,000 About 5% of all cancers Local Recurrence:
More informationSelf-Assessment Module 2016 Annual Refresher Course
LS16031305 The Management of s With r. Lin Learning Objectives: 1. To understand the changing demographics of oropharynx cancer, and the impact of human papillomavirus on overall survival and the patterns
More informationLarynx Hypopharynx. Therapy algorithms. Why larynx preservation at all? State of the art Jean Louis Lefebvre,Lille Jan Klozar,Prague
Larynx Hypopharynx Moderation Rainald Knecht,Hamburg State of the art Jean Louis Lefebvre,Lille Debate pro CRT Jan Klozar,Prague contra CRT Marshall Posner,Boston Clinical cases all Therapy algorithms
More informationRADIO- AND RADIOCHEMOTHERAPY OF HEAD AND NECK TUMORS. Zoltán Takácsi-Nagy PhD Department of Radiotherapy National Institute of Oncology, Budapest 1.
RADIO- AND RADIOCHEMOTHERAPY OF HEAD AND NECK TUMORS Zoltán Takácsi-Nagy PhD Department of Radiotherapy National Institute of Oncology, Budapest 1. 550 000 NEW PATIENTS/YEAR WITH HEAD AND NECK CANCER ALL
More informationRT +/- Surgery. Concurrent ChemoRT +/- Surgery
Molecular targeted approaches to head and neck cancer Lillian L. Siu Department of Medical Oncology & Hematology Princess Margaret Hospital, University of Toronto Locally Advanced HNSCC Locally Advanced
More informationCetuximab/cisplatin and radiotherapy in HNSCC: is there a favorite choice?
Cent. Eur. J. Med. 9(2) 2014 279-284 DOI: 10.2478/s11536-013-0154-9 Central European Journal of Medicine Cetuximab/cisplatin and radiotherapy in HNSCC: is there a favorite choice? Jacopo Giuliani* 1, Marina
More informationTherapy of Locally Advanced Head and Neck Cancer: State of the Art
Therapy of Locally Advanced Head and Neck Cancer: State of the Art Barbara Burtness, MD Chief, Head and Neck ncology Medical ncology Co-Leader Senior Member Fox Chase Cancer Center Philadelphia, PA Therapy
More informationClinical Trials in Transoral Endoscopic Head &Neck Surgery ECOG3311 and RTOG1221. Chris Holsinger, MD, FACS Bob Ferris, MD, PhD, FACS
Clinical Trials in Transoral Endoscopic Head &Neck Surgery ECOG3311 and RTOG1221 Chris Holsinger, MD, FACS Bob Ferris, MD, PhD, FACS 1 Disclosure I have no conflicts of interest to disclose 2 Robotic H&N
More informationMANAGEMENT OF CA HYPOPHARYNX
MANAGEMENT OF CA HYPOPHARYNX GENERAL TREATMENT RECOMMENDATIONS BASED ON HYPOPHARYNX TUMOR STAGE For patients presenting with early-stage definitive radiotherapy alone or voice-preserving surgery are viable
More informationImmunotherapy for the Treatment of Head and Neck Cancers. Robert F. Taylor, MD Aurora Health Care
Immunotherapy for the Treatment of Head and Neck Cancers Robert F. Taylor, MD Aurora Health Care Disclosures No relevant financial relationships to disclose I will be discussing non-fda approved indications
More informationCALGB Thoracic Radiotherapy for Limited Stage Small Cell Lung Cancer
CALGB 30610 Thoracic Radiotherapy for Limited Stage Small Cell Lung Cancer Jeffrey A. Bogart Department of Radiation Oncology Upstate Medical University Syracuse, NY Small Cell Lung Cancer Estimated 33,000
More informationPractice teaching course on head and neck cancer management
28-29 October 2016 - Saint-Priest en Jarez, France Practice teaching course on head and neck cancer management IMPROVING THE PATIENT S LIFE THROUGH MEDICAL EDUCATION www.excemed.org Nicolas Magné France
More informationNon-small Cell Lung Cancer: Multidisciplinary Role: Role of Medical Oncologist
Non-small Cell Lung Cancer: Multidisciplinary Role: Role of Medical Oncologist Vichien Srimuninnimit, MD. Medical Oncology Division Faculty of Medicine, Siriraj Hospital Outline Resectable NSCLC stage
More informationCURRENT STANDARD OF CARE IN NASOPHARYNGEAL CANCER
CURRENT STANDARD OF CARE IN NASOPHARYNGEAL CANCER Jean-Pascal Machiels Department of medical oncology Institut I Roi Albert II Cliniques universitaires Saint-Luc Université catholique de Louvain, Brussels,
More informationNon-surgical treatment for locally advanced head and neck squamous cell carcinoma: beyond the upper limit
Editorial Non-surgical treatment for locally advanced head and neck squamous cell carcinoma: beyond the upper limit Hiroto Ishiki, Satoru Iwase Department of Palliative Medicine, The Institute of Medical
More informationCombined Modality Therapy State of the Art. Everett E. Vokes The University of Chicago
Combined Modality Therapy State of the Art Everett E. Vokes The University of Chicago What we Know Some patients are cured (20%) Induction and concurrent chemoradiotherapy are each superior to radiotherapy
More informationConcurrent Chemo- and Radiotherapy for Ororpharynx Cancer
Concurrent Chemo- and Radiotherapy for Ororpharynx Cancer Faye Johnson MD, PhD Associate Professor Thoracic/Head and Neck Medical Oncology August 2017 Objectives Review data that support concurrent chemo-
More informationHead & Neck Cancer: When to Irradiate
Head & Neck Cancer: When to Irradiate ESO-ESMO Latin-America 2018 Talented students colleagues 1 > 15 different diseases for RT strategies NC NP OC OP H L 2 HPV Prognostic Marker >2010 Trial Cases Marker
More informationTwo Cycles of Chemoradiation: 2 Cycles is Enough. Concurrent Chemotherapy / RT Regimens
1 Two Cycles of Chemoradiation: 2 Cycles is Enough Heather Wakelee, M.D. Assistant Professor of Medicine, Oncology Stanford University Concurrent Chemotherapy / RT Regimens Cisplatin 50 mg/m 2 on days
More informationOral Cavity Cancer Combined modality therapy
Oral Cavity Cancer Combined modality therapy Dr. Christos CHRISTOPOULOS Radiation Oncologist Head and Neck Cancers Centre Hospitalier Universitaire (C.H.U.) de Limoges, France Disclosure slide I have no
More informationHead and Neck Cancer Update Sandro V Porceddu
Head and Neck Cancer Update Sandro V Porceddu Director, Radiation Oncology Research Princess Alexandra Hospital, Brisbane Associate Professor, University of Queensland President, Trans Tasman Radiation
More informationTratamiento Multidisciplinar de Estadios Localmente Avanzados en Cáncer de Pulmón
Tratamiento Multidisciplinar de Estadios Localmente Avanzados en Cáncer de Pulmón Santiago Ponce Aix Servicio Oncología Médica Hospital Universitario 12 de Octubre Madrid Stage III: heterogenous disease
More informationRADIATION THERAPY AND CHEMOTHERAPY IN LOCALLY ADVANCED CANCER OF THE HEAD AND NECK Carlos A. Perez, M.D. Former Chairman/Professor Emeritus
RADIATION THERAPY AND CHEMOTHERAPY IN LOCALLY ADVANCED CANCER OF THE HEAD AND NECK Carlos A. Perez, M.D. Former Chairman/Professor Emeritus Department of Radiation Oncology Mallinckrodt Institute of Radiology/
More informationAdvances in gastric cancer: How to approach localised disease?
Advances in gastric cancer: How to approach localised disease? Andrés Cervantes Professor of Medicine Classical approach to localised gastric cancer Surgical resection Pathology assessment and estimation
More informationHead&Neck, and Thyroid Cancers: Incorporating New Therapies into Current Treatment Algorithms
Head&Neck, and Thyroid Cancers: Incorporating New Therapies into Current Treatment Algorithms Robert Haddad, MD Disease Center Leader Head and Neck Oncology Program Dana Farber Cancer Institute Harvard
More informationProtocol of Radiotherapy for Head and Neck Cancer
106 年 12 月修訂 Protocol of Radiotherapy for Head and Neck Cancer Indication of radiotherapy Indication of definitive radiotherapy with or without chemotherapy (1) Resectable, but medically unfit, or high
More informationAccepted 28 April 2005 Published online 13 September 2005 in Wiley InterScience ( DOI: /hed.
DEFINING RISK LEVELS IN LOCALLY ADVANCED HEAD AND NECK CANCERS: A COMPARATIVE ANALYSIS OF CONCURRENT POSTOPERATIVE RADIATION PLUS CHEMOTHERAPY TRIALS OF THE EORTC (#22931) AND RTOG (#9501) Jacques Bernier,
More informationPresent and Future of Head and Neck Cancer Therapy (Focus at systemic therapy)
Present and Future of Head and Neck Cancer Therapy (Focus at systemic therapy) Jan B; Vermorken, MD, PhD Department of Medical Oncology Antwerp University Hospital Edegem, Belgium 1st Hellenic Conference
More informationTREATMENT TIME & TOBACCO: TWIN TERRORS Of H&N Therapy
TREATMENT TIME & TOBACCO: TWIN TERRORS Of H&N Therapy Anurag K. Singh, MD Professor of Medicine University at Buffalo School of Medicine Professor of Oncology Director of Radiation Research Roswell Park
More informationGASTRIC & PANCREATIC CANCER
GASTRIC & PANCREATIC CANCER ASCO HIGHLIGHTS 2005 Fadi Sami Farhat, MD Head of Hematology Oncology Division Hammoud Hospital University Medical Center Saida Lebanon Tel: +961 3 753 155 E-Mail: drfadi@drfadi.org
More informationASCO Highlights Head and Neck Cancer
ASCO Highlights Head and Neck Cancer Anne S. Tsao, M.D. Director, Mesothelioma Program Assistant Professor July 11, 2009 The University of Texas MD ANDERSON CANCER CENTER Department of Thoracic/Head &
More informationGuillaume Janoray, Yoann Pointreau, Pascal Garaud, Sophie Chapet, Marc Alfonsi, Christian Sire, Eric Jadaud, Gilles Calais
JNCI J Natl Cancer Inst (016) 108(4): djv368 doi:10.1093/jnci/djv368 First published online December 16, 015 Article Long-Term Results of a Multicenter Randomized Phase III Trial of Induction Chemotherapy
More informationHPV POSITIVE OROPHARYNGEAL CARCINOMA the radiation oncologist point of view. Prof. dr. Sandra Nuyts Dep. Radiation-Oncology UH Leuven Belgium
HPV POSITIVE OROPHARYNGEAL CARCINOMA the radiation oncologist point of view Prof. dr. Sandra Nuyts Dep. Radiation-Oncology UH Leuven Belgium HEAD AND NECK CANCER -HPV Change in incidence: HEAD AND NECK
More informationAccepted 20 April 2009 Published online 25 June 2009 in Wiley InterScience (www.interscience.wiley.com). DOI: /hed.21179
ORIGINAL ARTICLE DOCETAXEL, CISPLATIN, AND FLUOROURACIL INDUCTION CHEMOTHERAPY FOLLOWED BY ACCELERATED FRACTIONATION/CONCOMITANT BOOST RADIATION AND CONCURRENT CISPLATIN IN PATIENTS WITH ADVANCED SQUAMOUS
More informationThoracic and head/neck oncology new developments
Thoracic and head/neck oncology new developments Goh Boon Cher Department of Hematology-Oncology National University Cancer Institute of Singapore Research Clinical Care Education Scope Lung cancer Screening
More informationOral cavity cancer Post-operative treatment
Oral cavity cancer Post-operative treatment Dr. Christos CHRISTOPOULOS Radiation Oncologist Centre Hospitalier Universitaire (C.H.U.) de Limoges, France Important issues RT -techniques Patient selection
More information17th ESO-ESMO Masterclass Clinical Oncology
Chemoradiotherapy and Systemic Therapy in Squamous Cell Carcinoma of the Head and Neck (SCCHN) Jan B. Vermorken, MD, PhD Department of Medical Oncology Antwerp University Hospital Edegem, Belgium 17 th
More informationImmunotherapy for the Treatment of Head and Neck Cancers. Barbara Burtness, MD Yale University
Immunotherapy for the Treatment of Head and Neck Cancers Barbara Burtness, MD Yale University Disclosures AstraZeneca Pharmaceuticals LP, Boehringer Ingelheim, Bristol-Myers Squibb, Merck & Co., Inc.,
More informationSquamous Cell Carcinoma of the Oral Cavity: Radio therapeutic Considerations
Squamous Cell Carcinoma of the Oral Cavity: Radio therapeutic Considerations Troy G. Scroggins Jr. MD Chairman, Department of Radiation Oncology Ochsner Health Systems 1 Association of Postoperative Radiotherapy
More informationNew Paradigms for Treatment of. Erminia Massarelli, MD, PHD, MS Clinical Associate Professor
New Paradigms for Treatment of Head and Neck cancers Erminia Massarelli, MD, PHD, MS Clinical Associate Professor City of Hope Disclosure Statement Grant/Research Support frommerck Bristol Grant/Research
More informationES-SCLC Joint Case Conference. Anthony Paravati Adam Yock
ES-SCLC Joint Case Conference Anthony Paravati Adam Yock Case 57 yo woman with 35 pack year smoking history presented with persistent cough and rash Chest x-ray showed a large left upper lobe/left hilar
More informationTreatment Deintensification Strategies for HPV-Related Head and Neck Cancer. Barbara Burtness, MD April, 2018
Treatment Deintensification Strategies for HPV-Related Head and Neck Cancer Barbara Burtness, MD April, 2018 Head and Neck Cancer Treatment Curative therapy with surgery or radiation Post operative adjuvant
More informationRadio(chemo)therapy for head and neck cancer HNSCC: indications and modalities Prof. dr. Sandra Nuyts Radiotherapy-Oncology
Radio(chemo)therapy for head and neck cancer HNSCC: indications and modalities Prof. dr. Sandra Nuyts Radiotherapy-Oncology March 2018 > Half million new cases HNC/year in world 50-60% cured not cured
More informationClinical Discussion. Dr Pankaj Chaturvedi. Professor and Surgeon Tata Memorial Hospital
Clinical Discussion Dr Pankaj Chaturvedi Professor and Surgeon Tata Memorial Hospital chaturvedi.pankaj@gmail.com 47/M/smoker Hopkins : Transglottic lesion No cartilage infiltration but sclerosis Left
More informationStage III NSCLC: Overview
Locally Advanced NSCLC: New Concepts in Combined Modality Therapy NSCLC: Stage Distribution Randeep Sangha, MD Visiting Assistant Professor UC Davis Cancer Center Sacramento, CA Stage III NSCLC: Overview
More information5/20/ ) Haffty GB: Concurrent chemoradiation in the treatment of head and neck cancer. Hematol. Oncol. Clin: North Am.
Prague, 24-25 25 April 29 ALTERNATING CHEMORADIATION: FOR WHOM? M. Merlano MD Holy Cross Gen. Hospital Cuneo - Italy ALTERNATING CHEMORADIATION: FOR WHOM? Definition of alternating chemoradiation Targets
More informationRob Glynne-Jones Mount Vernon Cancer Centre
ESMO Preceptorship Programme Colorectal Cancer Prague July 2016 State of the art: Standard of care for anal squamous cancer Rob Glynne-Jones Mount Vernon Cancer Centre Aim to discuss Background The trials
More informationThomas Gernon, MD Otolaryngology THE EVOLVING TREATMENT OF SCCA OF THE OROPHARYNX
Thomas Gernon, MD Otolaryngology THE EVOLVING TREATMENT OF SCCA OF THE OROPHARYNX Disclosures I have nothing to disclose. 3 Changing Role of Surgery N=42,688 Chen Ay et al. Larygoscope. 2007; 117:16-21
More informationComparing Alternative treatment Regimens for intermediate and high risk oropharyngeal cancer CompARE. Prof. Hisham Mehanna.
Comparing Alternative treatment Regimens for intermediate and high risk oropharyngeal cancer CompARE Prof. Hisham Mehanna Chief investigator: Hisham Mehanna Arm 1: Mehmet Sen Arm2: John Chester/Martin
More informationMedicinae Doctoris. One university. Many futures.
Medicinae Doctoris The Before and The After: Can chemotherapy revise the trajectory of gastric and esophageal cancers? Dr. David Dawe MD, FRCPC Medical Oncologist Assistant Professor Disclosures None All
More informationHeterogeneity of N2 disease
Locally Advanced NSCLC Surgery? No. Ramaswamy Govindan M.D Co-Director, Section of Medical Oncology Alvin J Siteman Cancer Center at Washington University School of Medicine St. Louis, Missouri Heterogeneity
More informationNasopharyngeal Cancer:Role of Chemotherapy
Nasopharyngeal Cancer:Role of Chemotherapy PANAGIOTIS KATSAOUNIS Medical Oncologist IASO GENERAL HOSPITAL Athens, 16/9/2017 2 nd Hellenic Multidisciplinary Conference on Head and Neck Cancer INTRODUCTION
More informationComparative study of Gemcitabine versus Cisplatin concurrent with radiotherapy for locally advanced head and neck cancer
Journal of Cancer Treatment and Research 2014; 2(4): 37-44 Published online August 30, 2014 (http://www.sciencepublishinggroup.com/j/jctr) doi: 10.11648/j.jctr.20140204.12 Comparative study of Gemcitabine
More informationDiagnosis and what happens after referral
Diagnosis and what happens after referral Dr Kate Newbold Consultant in Clinical Oncology The Royal Marsden Women's cancers Breast cancer introduction 1 Treatment Modalities Early stage disease -larynx
More informationMANAGEMENT OF LOCALLY ADVANCED OROPHARYNGEAL CANER: HPV AND NON-HPV MEDIATED CANCERS
MANAGEMENT OF LOCALLY ADVANCED OROPHARYNGEAL CANER: HPV AND NON-HPV MEDIATED CANCERS Kyle Arneson, MD PhD Avera Medical Group Radiation Oncology Avera Cancer Institute 16 th Annual Oncology Symposium September
More informationCombined modality treatment for N2 disease
Combined modality treatment for N2 disease Dr Clara Chan Consultant in Clinical Oncology 3 rd March 2017 Overview Background The evidence base Systemic treatment Radiotherapy Future directions/clinical
More informationLaryngeal Conservation
Laryngeal Conservation Sarah Rodriguez, MD Faculty Advisor: Shawn Newlands, MD, PhD The University of Texas Medical Branch Department of Otolaryngolgy Grand Rounds Presentation February 2005 Introduction
More informationSanguineti s (2)Comment: When it was initially published in 2003 with a median follow-up of 3.8 years (4), the RTOG study led to a change in
Commento di due Soci AIRO pubblicati su due prestigiose riviste internazionali al Trial della forastiere et al. Long term results of RTOG:91-11 (a cura di Dr. Russi e Dr. Testolin )! Forastiere)et)al.)Long/Term)Results)of)RTOG)91/11:)A)Comparison)of)
More informationNasopharyngeal Cancer/Multimodality Treatment
Nasopharyngeal Cancer/Multimodality Treatment PANAGIOTIS KATSAOUNIS Medical Oncologist IASO GENERAL HOSPITAL Athens, 22/10/2016 1 st Hellenic Multidisciplinary Conference on Head and Neck Cancer INTRODUCTION
More informationThe Role of Docetaxel in the Treatment of Head and Neck Cancer
GBMC Head and Neck Conference The Role of Docetaxel in the Treatment of Head and Neck Cancer Simon Best December 7, 2007 Needs assessment: Providers who participate in the care of head and neck cancer
More informationPost-Operative Concurrent Chemoradiation with Mitomycin-C for Advanced Head and Neck Cancer
Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 2006 Post-Operative Concurrent Chemoradiation with Mitomycin-C for
More informationComparison of acute toxicities and response of standard chemo radiation versus hyper fractionated radiotherapy in head and neck cancers
Original Research Article Comparison of acute toxicities and response of standard chemo radiation versus hyper fractionated radiotherapy in head and neck cancers Kuppa Prakash 1*, A. Ravi Chandran 2, M.
More informationORIGINAL ARTICLE CHEMOTHERAPY ALONE FOR ORGAN PRESERVATION IN ADVANCED LARYNGEAL CANCER
ORIGINAL ARTICLE CHEMOTHERAPY ALONE FOR ORGAN PRESERVATION IN ADVANCED LARYNGEAL CANCER Vasu Divi, MD, 1 * Francis P. Worden, MD, 1,2 * Mark E. Prince, MD, 1 Avraham Eisbruch, MD, 3 Julia S. Lee, MD, 4
More informationScottish Medicines Consortium
Scottish Medicines Consortium cetuximab 2mg/ml intravenous infusion (Erbitux ) (279/06) MerckKGaA No 9 June 2006 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product
More informationNICE guideline Published: 10 February 2016 nice.org.uk/guidance/ng36
Cancer of the upper aerodigestive e tract: assessment and management in people aged 16 and over NICE guideline Published: 10 February 2016 nice.org.uk/guidance/ng36 NICE 2018. All rights reserved. Subject
More informationPERIOPERATIVE TREATMENT OF NON SMALL CELL LUNG CANCER. Virginie Westeel Chest Disease Department University Hospital Besançon, France
PERIOPERATIVE TREATMENT OF NON SMALL CELL LUNG CANCER Virginie Westeel Chest Disease Department University Hospital Besançon, France LEARNING OBJECTIVES 1. To understand the potential of perioperative
More informationCANCERS of OROPHARYNX and HYPOPHARYNX. STAGING and TREATMENT
1 CANCERS of OROPHARYNX and HYPOPHARYNX STAGING and TREATMENT 2 1. Staging 2. General Principles of Treatment 3. Site Specific Treatment Guidelines 4. Selected Abstracts from Relevant Studies 3 1. Staging
More informationUpdate on Limited Small Cell Lung Cancer. Laurie E Gaspar MD, MBA Prof/Chair Radiation Oncology University of Colorado Denver
Update on Limited Small Cell Lung Cancer Laurie E Gaspar MD, MBA Prof/Chair Radiation Oncology University of Colorado Denver Objectives - Limited Radiation Dose Radiation Timing Radiation Volume PCI Neurotoxicity
More informationThe International Federation of Head and Neck Oncologic Societies. Current Concepts in Head and Neck Surgery and Oncology
The International Federation of Head and Neck Oncologic Societies Current Concepts in Head and Neck Surgery and Oncology 2018 www.ifhnos.net The International Federation of Head and Neck Oncologic Societies
More informationINAS I. ABDELHALIM, M.D.; NAWAL M. ELSAID, M.D.; ELSAID M. ALI, M.D. and BASHEER S. ATA, M.Sc.
Med. J. Cairo Univ., Vol. 81, No. 1, December: 887-893, 2013 www.medicaljournalofcairouniversity.net Neoadjuvant Docetaxel (Taxotere) Plus Cisplatin and 5-Flurouracil Followed by Concomitent Chemoradiotherapy
More informationAdjuvant Chemotherapy
State-of-the-art: standard of care for resectable NSCLC Adjuvant Chemotherapy JY DOUILLARD MD PhD Professor of Medical Oncology Integrated Centers of Oncology R Gauducheau University of Nantes France Adjuvant
More informationLocally advanced disease & challenges in management
Gynecologic Cancer InterGroup Cervix Cancer Research Network Cervix Cancer Education Symposium, February 2018 Locally advanced disease & challenges in management Carien Creutzberg Radiation Oncology, Leiden
More informationRTOG Lung Cancer Committee 2012 Clinical Trial Update. Wally Curran RTOG Group Chairman
RTOG Lung Cancer Committee 2012 Clinical Trial Update Wally Curran RTOG Group Chairman 1 RTOG Lung Committee: Active Trials Small Cell Lung Cancer Limited Stage (Intergroup Trial) Extensive Stage (RTOG
More informationD SCL C OS O UR U E R S
HPV-Associated Head and Neck Cancer: Controversies and Challenges NONE DISCLOSURES RESEARCH: Lilly, GSK, MERCK Stuart J. Wong, MD Associate Professor of Medicine and Otolaryngology Medical College of Wisconsin
More informationLung Cancer Epidemiology. AJCC Staging 6 th edition
Surgery for stage IIIA NSCLC? Sometimes! Anne S. Tsao, M.D. Associate Professor Director, Mesothelioma Program Director, Thoracic Chemo-Radiation Program May 7, 2011 The University of Texas MD ANDERSON
More informationHead, Neck, and Thyroid Cancers: Evidence-Based Approaches to Multimodal Management
Head, Neck, and Thyroid Cancers: Evidence-Based Approaches to Multimodal Management Robert Haddad, MD Disease Center Leader Head and Neck Oncology Program Dana Farber Cancer Institute Harvard Medical School
More informationTargeted Agents as Maintenance Therapy. Karen Kelly, MD Professor of Medicine UC Davis Cancer Center
Targeted Agents as Maintenance Therapy Karen Kelly, MD Professor of Medicine UC Davis Cancer Center Disclosures Genentech Advisory Board Maintenance Therapy Defined Treatment Non-Progressing Patients Drug
More informationThe effect of induction chemotherapy followed by chemoradiotherapy in advanced head and neck cancer: a prospective study
International Journal of Research in Medical Sciences Nikam BM et al. Int J Res Med Sci. 2014 May;2(2):476-480 www.msjonline.org pissn 2320-6071 eissn 2320-6012 Research Article DOI: 10.5455/2320-6012.ijrms20140519
More information