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1、Version 2.2013, 05/29/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. NCCN Guidelines Index Head and Neck Table of Contents Discussion NCCN.org Contin
2、ue NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ) Head and Neck Cancers Version 2.2013 Version 2.2013, 05/29/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express wri
3、tten permission of NCCN. NCCN Guidelines Index Head and Neck Table of Contents Discussion NCCN Guidelines Version 2.2013 Panel Members Head and Neck Cancers David G. Pfister, MD/Chair Memorial Sloan-Kettering Cancer Center Kie-Kian Ang, MD, PhD The University of Texas MD Anderson Cancer Center David
4、 M. Brizel, MD Duke Cancer Institute Barbara A. Burtness, MD Fox Chase Cancer Center Paul M. Busse, MD, PhD Massachusetts General Hospital Cancer Center Jimmy J. Caudell, MD, PhD Moffitt Cancer Center Anthony J. Cmelak, MD Vanderbilt-Ingram Cancer Center A. Dimitrios Colevas, MD Stanford Cancer Inst
5、itute Frank Dunphy, MD Duke Cancer Institute David W. Eisele, MD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Jill Gilbert, MD Vanderbilt-Ingram Cancer Center Bharat B. Mittal, MD Robert H. Lurie Comprehensive Cancer Center of Northwestern University Harlan A. Pinto, MD Stanford Ca
6、ncer Institute John A. Ridge, MD, PhD Fox Chase Cancer Center Sandeep Samant, MD St. Jude Childrens Research Hospital/ University of Tennessee Health Science Center David E. Schuller, MD The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute Jatin
7、 P. Shah, MD, PhD Memorial Sloan-Kettering Cancer Center Sharon Spencer, MD University of Alabama at Birmingham Comprehensive Cancer Center Randal S. Weber, MD The University of Texas MD Anderson Cancer Center Gregory T. Wolf, MD University of Michigan Comprehensive Cancer Center Frank Worden, MD Un
8、iversity of Michigan Comprehensive Cancer Center Sue S. Yom, MD, PhD UCSF Helen Diller Family Comprehensive Cancer Center ? Maura L. Gillison, MD, PhD The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute Robert I. Haddad, MD Dana-Farber/Brigham
9、and Womens Cancer Center Bruce H. Haughey, MBChB, MS Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine Wesley L. Hicks, Jr., MD Roswell Park Cancer Institute Ying J. Hitchcock, MD Huntsman Cancer Institute at the University of Utah Merrill S. Kies, MD The U
10、niversity of Texas MD Anderson Cancer Center William M. Lydiatt, MD UNMC Eppley Cancer Center at The Nebraska Medical Center Ellie Maghami, MD City of Hope Comprehensive Cancer Center Renato Martins, MD, MPH Fred Hutchinson Cancer Research Center/ Seattle Cancer Care Alliance Thomas McCaffrey, MD, P
11、hD Moffitt Cancer Center ? ? ? * Medical oncology Surgery/Surgical oncology Radiation oncology Otolaryngology Internal medicine ? * Writing Committee Member NCCN Guidelines Panel Disclosures * Continue NCCN Lauren Gallagher, RPh, PhD Miranda Hughes, PhD Nicole McMillian, MS * * * * * Printed by wang
12、 zeyu on 6/16/2013 8:30:52 AM. For personal use only. Not approved for distribution. Copyright 2013 National Comprehensive Cancer Network, Inc., All Rights Reserved. Version 2.2013, 05/29/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustrat
13、ion may not be reproduced in any form without the express written permission of NCCN. NCCN Guidelines Index Head and Neck Table of Contents Discussion NCCN Guidelines Version 2.2013 Sub-Committees Head and Neck Cancers Continue Mucosal Melanoma William M. Lydiatt, MD/Lead UNMC Eppley Cancer Center a
14、t The Nebraska Medical Center Jatin P. Shah, MD, PhD Memorial Sloan-Kettering Cancer Center ? Medical oncology Surgery/Surgical oncology Radiation oncology Otolaryngology Internal medicine ? NCCN Guidelines Panel Disclosures Principles of Radiation Therapy Sharon Spencer, MD/Lead University of Alaba
15、ma at Birmingham Comprehensive Cancer Center Kie-Kian Ang, MD, PhD The University of Texas MD Anderson Cancer Center David Brizel, MD Duke Cancer Institute Paul M. Busse, MD, PhD Massachusetts General Hospital Cancer Center Jimmy J. Caudell, MD, PhD Moffitt Cancer Center Anthony J. Cmelak, MD Vander
16、bilt-Ingram Cancer Center Ying J. Hitchcock, MD Huntsman Cancer Institute at the University of Utah Bharat B. Mittal, MD Robert H. Lurie Comprehensive Cancer Center of Northwestern University Sue S. Yom, MD, PhD UCSF Helen Diller Family Comprehensive Cancer Center Principles of Surgery Gregory T. Wo
17、lf, MD/Lead University of Michigan Comprehensive Cancer Center David M. Brizel, MD Duke Cancer Institute David W. Eisele, MD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins William M. Lydiatt, MD UNMC Eppley Cancer Center at The Nebraska Medical Center John A. Ridge, MD, PhD Fox Chase
18、 Cancer Center Sandeep Samant, MD St. Jude Childrens Research Hospital/ University of Tennessee Health Science Center David E. Schuller, MD The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute Randal S. Weber, MD The University of Texas MD Ander
19、son Cancer Center ? ? Principles of Systemic Therapy Barbara A. Burtness, MD Fox Chase Cancer Center A. Dimitrios Colevas, MD Stanford Cancer Institute Frank Dunphy, MD Duke Cancer Institute Robert I. Haddad, MD Dana-Farber/Brigham and Womens Cancer Center Renato Martins, MD, MPH Fred Hutchinson Can
20、cer Research Center/ Seattle Cancer Care Alliance Frank Worden, MD University of Michigan Comprehensive Cancer Center Principles of Nutrition A. Dimitrios Colevas, MD/Lead Stanford Cancer Institute Paul M. Busse, MD, PhD Massachusetts General Hospital Cancer Center Ying J. Hitchcock, MD Huntsman Can
21、cer Institute at the University of Utah Gregory T. Wolf, MD University of Michigan Comprehensive Cancer Center ? Printed by wang zeyu on 6/16/2013 8:30:52 AM. For personal use only. Not approved for distribution. Copyright 2013 National Comprehensive Cancer Network, Inc., All Rights Reserved. Versio
22、n 2.2013, 05/29/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. NCCN Guidelines Index Head and Neck Table of Contents Discussion NCCN Head Neck Cancer
23、s Panel Members NCCN Head and Cancers Sub-Committee Members Summary of the Guidelines Updates Multidisciplinary Team and Support Services (TEAM-1) Cancer of the Lip (LIP-1) Cancer of the Oral Cavity (OR-1) Cancer of the Oropharynx (ORPH-1) Cancer of the Hypopharynx (HYPO-1) Cancer of the Nasopharynx
24、 (NASO-1) Cancer of the Glottic Larynx (GLOT-1) Cancer of the Supraglottic Larynx (SUPRA-1) Ethmoid Sinus Tumors (ETHM-1) Maxillary Sinus Tumors (MAXI-1) Very Advanced Head and Neck Cancer (ADV-1) Recurrent/Persistent Head and Neck Cancer (ADV-2) Occult Primary (OCC-1) Salivary Gland Tumors (SALI-1)
25、 Mucosal Melanoma (MM-1) Follow-up Recommendations (FOLL-A) Principles of Surgery (SURG-A) Radiation Techniques (RAD-A) Principles of Systemic Therapy (CHEM-A) Staging (ST-1) ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?Principles of Nutrition: Management and Supportive Care (NUTR-A) Clinical Trials: Cate
26、gories of Evidence and Consensus: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. All recommendations are category 2A unless otherwise specified. NCCN To find clinical trials online at NCCN Member Instit
27、utions, click here: nccn.org/clinical_trials/physician.html. SeeNCCNCategories of Evidence and Consensus. The NCCN Guidelines are a statement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NC
28、CN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patients care or treatment. The National Comprehensive Cancer Network (NCCN) makes no representations or warranties of any kind regarding their content, use or applicati
29、on and disclaims any responsibility for their application or use in any way. The NCCN Guidelines are copyrighted by National Comprehensive Cancer Network. All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of
30、 NCCN. 2013. NCCN Guidelines Version 2.2013 Table of Contents Head and Neck Cancers Printed by wang zeyu on 6/16/2013 8:30:52 AM. For personal use only. Not approved for distribution. Copyright 2013 National Comprehensive Cancer Network, Inc., All Rights Reserved. Version 2.2013, 05/29/13 National C
31、omprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN. NCCN Guidelines Index Head and Neck Table of Contents Discussion NCCN Guidelines Version 2.2013 Updates Head and Ne
32、ck Cancers UPDATES 1 of 4 Global Changes ? ? ? The recommendation “Concurrent systemic therapy/RT, cisplatin (category 1) preferred” was revised for clarity. It now reads, “Concurrent systemic therapy/RT” with a corresponding footnote that states, “When using concurrent chemotherapy/RT, the preferre
33、d agent is cisplatin (category 1). See Principles of Systemic Therapy ()”. Clinical Staging: The phrase “not requiring total laryngectomy” changed to “amenable to larynx-preserving (conservation) surgery”. The phrase “requiring total laryngectomy” changed to “requiring (amenable to) total laryngecto
34、my”. The “Principles of Radiation” for each site were extensively revised including: CHEM-A ? ? ? ? ? The following footnotes were added for most sites: For doses 70 Gy, some clinicians feel that the fractionation should be slightly modified (eg, 70 Gy, some clinicians feel that the fractionation sh
35、ould be slightly modified (eg, 70 Gy, some clinicians feel that the fractionation should be slightly modified (eg, 70 Gy, some clinicians feel that the fractionation should be slightly modified (eg, 70 Gy, some clinicians feel that the fractionation should be slightly modified (eg, 70 Gy, some clini
36、cians feel that the fractionation should be slightly modified (eg, 70 Gy, some clinicians feel that the fractionation should be slightly modified (eg, 70 Gy, some clinicians feel that the fractionation should be slightly modified (eg, 70 Gy and treatment course 70 Gy, some clinicians feel that the f
37、ractionation should be slightly modified (eg, 70 Gy, some clinicians feel that the fractionation should be slightly modified (eg, 5 years, every 12 mo Post-treatment baseline imaging of primary (and neck, if treated) recommended within 6 mo of treatment (category 2B) Further reimaging as indicated b
38、ased on signs/symptoms; not routinely recommended for asymptomatic patients Chest imaging as clinically indicated for patients with smoking history Thyroid-stimulating hormone (TSH) every 6-12 mo if neck irradiated Speech/hearing and swallowing evaluation and rehabilitation as clinically indicated S
39、moking cessation and alcohol counseling as clinically indicated Dental evaluation Consider EBV monitoring for nasopharynx 2 3 4 ? ? ? ? ? ? ? ? ? ? ? ? Recommended for oral cavity and sites exposed to significant intraoral radiation treatment ()See NCCN Guidelines for Lung Cancer Screening FOLL-A Pr
40、inted by wang zeyu on 6/16/2013 8:30:52 AM. For personal use only. Not approved for distribution. Copyright 2013 National Comprehensive Cancer Network, Inc., All Rights Reserved. Version 2.2013, 05/29/13 National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and t
41、his illustration may not be reproduced in any form without the express written permission of NCCN. NCCN Guidelines Index Head and Neck Table of Contents Discussion Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any can
42、cer patient is in a clinical trial. Participation in clinical trials is especially encouraged. NCCN Guidelines Version 2.2013 Head and Neck Cancers PRINCIPLES OF SURGERY Evaluation Integration of Therapy Assessment of Resectability All patients should be evaluated by a head and neck surgical oncolog
43、ist prior to treatment to assure the following: Review the adequacy of biopsy material, review staging and imaging to determine the extent of disease, exclude the presence of a synchronous primary tumor, assess current functional status, and evaluate for potential surgical salvage if initial treatme
44、nt is non- surgical. Participate in the multidisciplinary team discussions regarding patient treatment options with the goal of maximizing survival with preservation of form and function. Develop a prospective surveillance plan that includes adequate dental, nutritional, and health behavior evaluati
45、on and intervention and any other ancillary evaluations that would provide for comprehensive rehabilitation. For patients undergoing an operation, the surgical procedure, margins, and reconstructive plan should be developed and designed to resect all gross tumors with adequate tumor-free surgical ma
46、rgins. The surgical procedure should not be modified based upon any response observed as a result of prior therapy except in instances of tumor progression that mandate a more extensive procedure in order to encompass the tumor at the time of definitive resection. It is critical that multidisciplina
47、ry evaluation and treatment be coordinated and integrated prospectively by all disciplines involved in patient care before the initiation of any treatment. Tumor involvement of the following sites is associated with poor prognosis or function or with T4b cancer (ie, unresectable based on technical a
48、bility to obtain clear margins): Involvement of the pterygoid muscles, particularly when associated with severe trismus or pterygopalatine fossa involvement with cranial neuropathy; Gross extension of the tumor to the skull base (eg, erosion of the pterygoid plates or sphenoid bone, widening of the
49、foramen ovale); Direct extension to the superior nasopharynx or deep extension into the Eustachian tube and lateral nasopharyngeal walls; Invasion (encasement) of the common or internal carotid artery. Encasement is usually assessed radiographically and defined as a tumor surrounding the carotid artery by 270 degrees or greater; Direct extension of neck disease to involve the external skin; Direct exten