Induction Chemotherapy for HNSCC

ICT today

• NPC
  • gem+cis ICT f/b CCRT: +OS benefit if EBV+ (NEJM 2019, JCO 2022)
• larynx preservation
  • CCRT not clearly better than ICT in pts who qualify for total laryngectomy but not partial - SALTORL trial is comparing ICT and CCRT head-to-head
• treatment intensification
  • TPF+CCRT in the fittest patients?
• converting borderline resectable to resectable
  • ~30% conversion rate
• oligometastatic disease
  • shrink/eliminate distant sites, spot weld prn, then CCRT/surgery?
• neurologic and airway compromise (i.e. true urgencies, nonoperable)
  • dental procedures wrt timing of RT, may need to start ICT to bridge until dental procedures are done plus ~2wks (h/t Ronak Mistry)