National Comprehensive Cancer Network

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NCCN Guidelines and Compendium Updated

Flash Update Sent May 1, 2012
NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers. These NCCN Guidelines® are currently available as Version 1.2012.

  • A "Principles of Nutrition: Management and Supportive Care" section was developed that includes recommendations for "Assessment and Management (nutrition, speech, and swallowing)" and "Use of Alternative Routes for Nutrition (NG and PEG Tubes)" for head and neck cancer patients.
  • The Principles of Radiation page for each cancer site was revised extensively.
  • Cancer of the Oropharynx
    • Under Workup, the recommendation "Tumor HPV testing suggested," changed to "Tumor HPV testing recommended".
    • "Consider chemo/RT (for T2 only)" was added as an adjuvant treatment option for patients with T1-2, N0-1 tumors, with adverse features and positive margins after resection. (A similar change was also made for hypopharynx.)
  • Cancer of the Glottic Larynx
    • For patients with T4a, Any N tumors, the adjuvant treatment recommendation changed from "Chemo/RT (category 1)" to "RT or Consider chemo/RT or Observation for highly selected patients".  A corresponding footnote regarding good risk features for favorable T4a patients who could be observed after surgery was also added.
  • Very Advanced Head and Neck Cancer
    • For patients with distant metastases and ECOG performance status 0-1, "Platinum + 5-FU + cetuximab (category 1)" was added as a treatment option.
  • Salivary Gland Tumors
    • The Workup recommendation "Open biopsy or consider fine-needle aspiration (may not be necessary in  incompletely resected patients)" changed to "Fine-needle biopsy".
  • Follow-up Recommendations
    • The page title clarifies that the follow-up recommendations are "based on risk of relapse, second primaries, treatment sequalae, and toxicities".
    • The history and physical exam schedule was revised.
  • Principles of Systemic Therapy
    • A new section of bulleted statements was added regarding therapy for locally advanced disease.
    • Under squamous cell cancers, "Primary systemic therapy + concurrent RT" for non-nasopharyngeal cancers, the "Carboplatin/infusional 5-FU" regimen was changed from category 2A to category 1.
    • For non-nasopharyngeal cancers: "Paclitaxel/cisplatin/infusional 5-FU" was added as an Induction/Sequential chemotherapy regimen.
    • A new section denoting Induction/Sequential chemotherapy for nasopharynx cancers was added as follows:
      • Induction/Sequential chemotherapy
      • Docetaxel/cisplatin/5-FU
      • Cisplatin/5-FU
      • Cisplatin/epirubicin/paclitaxel
      • Following induction, agents to be used with concurrent chemoradiation typically include weekly cisplatin or carboplatin.

For the complete updated version of these and all NCCN Guidelines, visit NCCN.org.