Treatment of locoregionally advanced (stage III and IV) head and neck cancer: The oropharynx
- Francis P Worden, MD
Francis P Worden, MD
- Department of Internal Medicine
- Division of Hematology and Oncology
- University of Michigan
- Carol R Bradford, MD, FACS
Carol R Bradford, MD, FACS
- Professor and Chair
- Department of Otolaryngology-Head and Neck Surgery
- University of Michigan
- Avraham Eisbruch, MD
Avraham Eisbruch, MD
- Professor and Associate Chair for Clinical Research
- Department of Radiation Oncology
- University of Michigan
- Section Editors
- Marshall R Posner, MD
Marshall R Posner, MD
- Section Editor — Cancer of the Head and Neck
- Professor of Gene and Cell Medicine
- The Tisch Cancer Institute
- Icahn School of Medicine at Mount Sinai
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Oropharyngeal squamous cell carcinomas originate in the soft palate, tonsils, base of tongue, pharyngeal wall, or the vallecula, the fold located between the base of tongue and the epiglottis (figure 1) . Oropharyngeal cancer is a relatively uncommon malignancy, with approximately 100,000 cases of oropharyngeal cancer diagnosed worldwide each year, which cause death in at least half of cases .
The tumor, node, metastasis (TNM) staging system of the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) is used to stage oropharyngeal cancer. In the eighth edition of the AJCC TNM staging system, separate staging systems have been established for HPV associated oropharyngeal carcinoma (figure 2 and table 1A and table 1B) and for HPV negative oropharyngeal cancer (table 2 and table 3) [3,4] (see "Overview of the diagnosis and staging of head and neck cancer"). The eighth edition AJCC staging system will go into effect in the United States in 2018, and this section will be updated. Comments in this section still apply to seventh edition AJCC unless otherwise noted.
The treatment of locally advanced, stage III to IVB cancers of the oropharynx will be reviewed here. The treatment of early stage oropharyngeal cancer is discussed separately, as is the management of patients with distant metastases (stage IVC).
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- EFFECT OF HPV INFECTION
- NONSURGICAL VERSUS SURGICAL APPROACHES
- FUNCTIONAL ORGAN PRESERVATION APPROACHES
- Chemotherapy plus RT versus RT alone
- Contemporary trials
- Induction chemotherapy
- - Induction chemotherapy followed by radiation with or without surgery (locoregional therapy) versus definitive locoregional therapy alone
- - Sequential induction chemotherapy followed by radiation with or without surgery (locoregional therapy) versus definitive locoregional therapy alone
- - Concurrent chemotherapy regimen
- Cetuximab versus a platinum regimen
- Radiation schedule and technique
- OLDER AND POOR PERFORMANCE STATUS PATIENTS
- MANAGEMENT OF THE NECK
- After definitive chemoradiotherapy
- After primary surgery
- POSTTREATMENT EVALUATION AND SURVEILLANCE
- SUMMARY AND RECOMMENDATIONS