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)

NEJM 2019

JCO 2022

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