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General principles for treatment selection

General principles for treatment selection. Jeffrey Myers MD PhD. General principles for treatment selection. Site/subsite Stage Histology Biomarkers. Site. Subsites. Tonsil Base of tongue Pharyngeal wall Soft palate. Histology. Grade Differentiation Status Ploidy Other Findings

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General principles for treatment selection

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  1. General principles fortreatment selection Jeffrey Myers MD PhD

  2. General principles fortreatment selection • Site/subsite • Stage • Histology • Biomarkers

  3. Site

  4. Subsites • Tonsil • Base of tongue • Pharyngeal wall • Soft palate

  5. Histology • Grade • Differentiation Status • Ploidy • Other Findings • Perineural Invasion • Extracapsular spread • Margin

  6. Biomarkers • HPV • p16 • EGFR • Genomic/Proteomic Profiles

  7. Molecular Classification Identifies a Subset of Human Papillomavirus–Associated Oropharyngeal Cancers With Favorable Prognosis Journal of Clinical Oncology, Vol 24, No 5 (February 10), 2006: pp. 736-747

  8. EGFR and SCCHN Treatment Outcomes L Milas & KK Ang J Clin Oncol. 2007 AK El-Naggar, JJ Lee , L Mao J Clin Oncol. 2007 KK Ang & L Milas Cancer Res. 2002

  9. Stage • T- Stage • Tx • Tis • T 1-2 • T 3-4 • N-Stage • N0 • N1 • >N1 • ECS • Overall Stage • Other Considerations • Depth of Invasion • Growth Pattern

  10. Myers,. Cancer 2002; 92(12):3030

  11. Greenberg. Cancer 2003;97:1464.

  12. Overall Stage and Treatment Selection: Cisplatin and Fluorouracil Alone or with Docetaxel in Head and Neck Cancer N Engl J Med. 2007 Oct 25;357(17):1705-15

  13. Treatment Options • Surgery • Radiation Therapy • Systemic Therapy • Chemoradiotherapy • Induction • Concurrent • Induction followed by Concurrent • Adjuvant • Targeted Molecular Therapy + Radiotherapy

  14. Surgery-Primary/Neck • Staging Surgery • Debulking Surgery • Definitive Surgery • Open Surgery • Transoral Microsurgery • Robotic surgery • Planned Surgery after non-surgical Therapy • Salvage Surgery

  15. Radiation Therapy • Particles • Electrons • Neutrons • Protons • Fields • Parallel Opposing • IMRT • Stereotactic Radiosurgery • Fractionation • Conventional • Hyperfractionation • Concomitant Boost • Hypofractionation

  16. Systemic Therapy: Chemotherapy/Biologic Therapy • Chemoprevention • Induction • Concomitant • Adjuvant

  17. Summary • Site, Stage, and Histology are our main guides for selecting therapy • More Level I evidence is needed to guide the use of biomarkers in impacting treatment choices • The menu of treatment options is large and individualized treatment decisions should be made by experienced multi-disciplinary teams keeping oncologic and quality of life issues in mind • Where possible it is best to use the fewest modalities needed to effect a cure

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