National Comprehensive Cancer Network

About NCCN

NCCN Flash Update: NCCN Guidelines and NCCN Compendium for Head and Neck Cancers

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Head and Neck Cancers. These NCCN Guidelines® are currently available as Version 1.2018.

  • Cancer of the Lip
    • Sentinel lymph node biopsy (category 2B) has been removed from the primary therapy options for T1-2, N0 disease. (LIP-2)
    • RT has been added as an adjuvant therapy option for patients with perineural/vascular/lymphatic invasion following surgical resection of a T1-2, N0 lesion. (LIP-2)
  • Cancer of the Oral Cavity
    • For patients with T3, N0; T1-3, N1-3; T4a, any N disease, RT has been removed as an adjuvant treatment option for those with extranodal extension with or without a positive margin. (OR-3)
  • Cancer of the Oropharynx
    • Workup and Clinical Staging (ORPH-1)
      • The first bullet has been revised: "Tumor human papillomavirus (HPV) testing by p16 immunohistochemistry (IHC) recommended required.”
      • New pathways have been included for p16-negative and p16 (HPV)-positive disease.
      • Footnote "g" has been added: "The clinical staging definitions take into consideration the new AJCC 8th edition staging for oropharynx cancer, while referencing the staging criteria previously used in clinical trials on the management of oropharynx cancer."
    • For p16-negative oropharyngeal cancer, the inclusion criteria have been revised for the option of RT + systemic therapy. The treatment option now reads, “For T1-T2, N1 only: RT + systemic therapy (category 2B for systemic therapy).” (ORPH-2)
    • New pages have been added with recommendations for p16 (HPV)-positive cancers of the oropharynx. (ORPHPV-1)
    • A new section has been added, titled, “Principles of p16 testing for HPV-mediated oropharyngeal cancer.” (ORPH-B)
  • Cancer of the Hypopharynx
    • Surgery recommendations have been revised and lymph node dissection recommendations have been clarified. (HYPO-1- HYPO-3, HYPO-5, GLOT-3- GLOT-6)
  • Cancer of the Nasopharynx
    • For T1, N1-3 disease, or T2-4, any N disease, the option of induction chemotherapy followed by chemo/RT has been changed from a category 3 recommendation to a category 2A. (NASO-2) (Also CHEM-A, 1 of 5)
    • The following has been added to the Principles of Radiation Therapy: “Proton therapy can be considered when normal tissue constraints cannot be met by photon-based therapy.” (NASO-A) (Also on ETHM-A, MAXI-A, ADV-A, SALI-A, and MM-A)
  • Cancer of the Glottic Larynx
    • Following surgery for stage T4a, any N disease, adjuvant therapy options have been added for those with adverse features (GLOT-6).
  • Ethmoid Sinus Tumors
    • An adjuvant therapy option has been added for those diagnosed after incomplete resection with no residual disease on physical exam, imaging and/or endoscopy, following primary surgery: “Consider systemic therapy/RT (category 2B) if adverse features.” (ETHM-3)
  • Maxillary Sinus Tumors
    • The following footnote has been removed for patients with T3-T4a, N0 disease: "For surgical resection, consider preoperative RT or preoperative systemic therapy/RT in select patients (category 2B)." (MAXI-3)
  • Very Advanced Head and Neck Cancer
    • The following primary treatment option has been added for those with a resectable locoregional recurrence without prior RT: “Induction chemotherapy (category 3) followed by RT or systemic therapy/RT.” (ADV-3)
    • Footnote "c" has been added: "When using concurrent systemic therapy/RT, the preferred agent is cisplatin (category 1). See Principles of Systemic Therapy (CHEM-A)." (ADV-3)
  • Occult Primary
    • For a level IV or V adenocarcinoma of neck node, after evaluation for infraclavicular primary, the definitive treatment has been revised: “Neck dissection if indicated + adjuvant treatment if indicated (see OCC-4).”  (OCC-2)
    • Indications have been revised for the following treatment options for poorly differentiated or nonkeratinizing squamous cell or not otherwise specified, or anaplastic (not thyroid), or squamous cell carcinoma:
      • "Neck dissection (preferred for N1 disease, single node ≤3 cm)"
      • "RT for N1, single node ≤3 cm (category 2B)"
      • "Induction chemotherapy for N2-3 (category 3) followed by systemic therapy/RT or RT"
  • Salivary Gland Tumors
    • Footnote “m” has been added for those with distant metastases: “Check androgen receptor (AR) status and HER2 status prior to treatment for distant metastases.” (SALI-4)
    • The following recurrence therapy options have been added for those with distant metastases and PS 0-3:
      • Androgen receptor (AR) therapy (ie. leuprolide, bicalutamide) if AR+
      • Trastuzumab if HER2+ (category 2B)
  • Radiation Techniques
    • Standard reirradiation doses have been added for 3D conformal RT and IMRT: “59.4–60 Gy at 1.8–2 Gy/fraction. Hyperfractionated schedule is 60 Gy at 1.2–1.5 Gy/fraction.” (RAD-A, 3 of 5)
  • Principles of Systemic Therapy
    • Weekly cisplatin (category 2B) has been added as an option to be used with concurrent chemoradiation following induction chemotherapy for cancers of the lip, oral cavity, oropharynx, hypopharynx, glottic larynx, supraglottic larynx, ethmoid sinus, maxillary sinus, and occult primary tumors. (CHEM-A, 1 of 5)
    • Systemic therapy for recurrent, unresectable or metastatic disease (with no surgery or RT option) (CHEM-A, 2 of 5):
      • Options have been reorganized to include first-line therapy options and second-line or subsequent therapy options.
      • Cisplatin/gemcitabine has been changed from a category 2A to a category 1 option for nasopharyngeal cancer.
      • Gemcitabine/vinorelbine has been removed from the therapy options for nasopharyngeal cancer.
      • Pembrolizumab has been added as a category 2B subsequent therapy option for those with previously treated, PD-L1-positive recurrent or metastatic nasopharyngeal cancer.
  • Principles of Nutrition
    • The following pain management recommendation has been added, including supporting references: “Assess pain from oral mucositis and prescribe gabapentin or doxepin as clinically indicated.” (NUTRA-A, 1 of 2)

 

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium®), the NCCN Biomarkers Compendium®, the NCCN Chemotherapy Order Templates (NCCN Templates®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients®, please visit NCCN.org/patients.

Free NCCN Guidelines apps for iPhone, iPad, and Android smartphones & tablets are now available! Visit NCCN.org/apps

About NCCN Flash Updates™ 
NCCN Flash Updates™ is a subscription service from NCCN that provides timely notification of updated and new information appearing in the NCCN Guidelines, the NCCN Compendium®, and other NCCN Content. 

Subscribe to NCCN Flash Updates™ 

Please note: The NCCN Third Party Content FTP site: ftp://ftp1.nccn.org/ThirdPartyContent/ has been updated. Licensees are solely responsible for obtaining permission from such third party to use any such Third Party Content in the Permitted Works.

National Comprehensive Cancer Network® (NCCN®)
275 Commerce Drive, Suite 300
Fort Washington, PA 19034
Telephone: +1 215.690.0300 Fax: +1 215.690.0280 
 

Access information on permissions and licensing of NCCN Content  

© 2018 National Comprehensive Cancer Network. All Rights Reserved.