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Title: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Head and Neck Cancers
Author: National Comprehensive Cancer Network

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NCCN Guidelines Index
Head and Neck Table of Contents
Discussion

®

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines )

Head and Neck
Cancers
Version 1.2015
NCCN.org

Continue

Version 1.2015, 05/12/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

Printed by Anupam Desai on 8/29/2015 11:09:18 PM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved.

NCCN Guidelines Version 1.2015 Panel Members
Head and Neck Cancers
* David G. Pfister, MD † Þ/Chair
Memorial Sloan Kettering Cancer Center
* Sharon Spencer, MD §/Vice-Chair
University of Alabama at Birmingham
Comprehensive Cancer Center
David M. Brizel, MD §
Duke Cancer Institute
Barbara Burtness, MD †
Yale Cancer Center/Smilow Cancer Hospital
Paul M. Busse, MD, PhD §
Massachusetts General Hospital
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 and Women’s Cancer Center
Bruce H. Haughey, MBChB, MS ¶ z
Siteman Cancer Center at Barnes-Jewish Hospital
and Washington University School of Medicine
Wesley L. Hicks, Jr., MD ¶
Roswell Park Cancer Institute

Jimmy J. Caudell, MD, PhD §
Moffitt Cancer Center

Ying J. Hitchcock, MD §
Huntsman Cancer Institute
at the University of Utah

Anthony J. Cmelak, MD §
Vanderbilt-Ingram Cancer Center

Antonio Jimeno, MD, PhD †
University of Colorado Cancer Center

A. Dimitrios Colevas, MD †
Stanford Cancer Institute

Merrill S. Kies, MD †
The University of Texas
MD Anderson Cancer Center

Frank Dunphy, MD †
Duke Cancer Institute
David W. Eisele, MD ¶
The Sidney Kimmel Comprehensive
Cancer Center at Johns Hopkins
Robert L. Foote, MD §
Mayo Clinic Cancer Center
Jill Gilbert, MD †
Vanderbilt-Ingram Cancer Center

NCCN Guidelines Index
Head and Neck Table of Contents
Discussion

Bharat B. Mittal, MD §
Robert H. Lurie Comprehensive Cancer
Center of Northwestern University
Harlan A. Pinto, MD † Þ
Stanford Cancer Institute
John A. Ridge, MD, PhD ¶
Fox Chase Cancer Center
Cristina P. Rodriguez, MD †
Fred Hutchinson Cancer Research Center/
Seattle Cancer Care Alliance
Sandeep Samant, MD ¶
St. Jude Children's Research Hospital/
The University of Tennessee Health Science
Center
Jatin P. Shah, MD, PhD ¶
Memorial Sloan Kettering Cancer Center
Randal S. Weber, MD ¶
The University of Texas
MD Anderson Cancer Center

William M. Lydiatt, MD ¶ z
Fred & Pamela Buffett Cancer Center

Gregory T. Wolf, MD ¶ z
University of Michigan
Comprehensive Cancer Center

Ellie Maghami, MD ¶ z
City of Hope Comprehensive Cancer Center

Frank Worden, MD †
University of Michigan
Comprehensive Cancer Center

Thomas McCaffrey, MD, PhD z
Moffitt Cancer Center

Sue S. Yom, MD, PhD §
UCSF Helen Diller Family
Comprehensive Cancer Center

Loren K. Mell, MD §
UC San Diego Moores Cancer Center
† Medical oncology
¶ Surgery/Surgical oncology
§ Radiation oncology
z Otolaryngology
Þ Internal medicine
* Writing Committee Member

Continue
NCCN Guidelines Panel Disclosures

NCCN
Fayna Ferkle, PharmD
Lauren Gallagher, RPh, PhD
Miranda Hughes, PhD
Nicole McMillian, MS

Version 1.2015, 05/12/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

Printed by Anupam Desai on 8/29/2015 11:09:18 PM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved.

NCCN Guidelines Version 1.2015 Sub-Committees
Head and Neck Cancers
Mucosal Melanoma
William M. Lydiatt, MD ¶ z/Lead
Fred & Pamela Buffett Cancer Center
Jatin P. Shah, MD, PhD ¶
Memorial Sloan Kettering Cancer Center

Principles of Radiation Therapy
Sharon Spencer, MD §/Lead
University of Alabama at Birmingham
Comprehensive Cancer Center

Principles of Surgery
Gregory T. Wolf, MD ¶ z/Lead
University of Michigan
Comprehensive Cancer Center

David Brizel, MD §
Duke Cancer Institute

David M. Brizel, MD §
Duke Cancer Institute

Principles of Systemic Therapy
David G. Pfister, MD † Þ/Lead
Memorial Sloan Kettering Cancer Center

Paul M. Busse, MD, PhD §
Massachusetts General Hospital
Cancer Center

A. Dimitrios Colevas, MD †
Stanford Cancer Institute

Jimmy J. Caudell, MD, PhD §
Moffitt Cancer Center

Frank Dunphy, MD †
Duke Cancer Institute
Robert I. Haddad, MD †
Dana-Farber/Brigham and Women’s
Cancer Center
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 Cancer Institute
at the University of Utah
Gregory T. Wolf, MD ¶ z
University of Michigan
Comprehensive Cancer Center

NCCN Guidelines Index
Head and Neck Table of Contents
Discussion

Anthony J. Cmelak, MD §
Vanderbilt-Ingram Cancer Center
Ying J. Hitchcock, MD §
Huntsman Cancer Institute
at the University of Utah
Loren K. Mell, MD §
UC San Diego Moores Cancer Center
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

Continue
NCCN Guidelines Panel Disclosures

David W. Eisele, MD ¶
The Sidney Kimmel Comprehensive
Cancer Center at Johns Hopkins
William M. Lydiatt, MD ¶ z
Fred & Pamela Buffett Cancer Center
John A. Ridge, MD, PhD ¶
Fox Chase Cancer Center
Sandeep Samant, MD ¶
St. Jude Children's Research Hospital/
The University of Tennessee Health
Science Center
Randal S. Weber, MD ¶
The University of Texas
MD Anderson Cancer Center

Principles of Dental Evaluation
and Management
Frank Worden, MD †
University of Michigan
Comprehensive Cancer Center

† Medical oncology
z Otolaryngology
¶ Surgery/Surgical oncology Þ Internal medicine
§ Radiation oncology

Version 1.2015, 05/12/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

Printed by Anupam Desai on 8/29/2015 11:09:18 PM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved.

Guidelines Index
NCCN Guidelines Version 1.2015 Table of Contents Head andNCCN
Neck Table of Contents
Head and Neck Cancers
Discussion

NCCN Head Neck Cancers 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 (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-3)
· Occult Primary (OCC-1)
· Salivary Gland Tumors (SALI-1)
· Mucosal Melanoma (MM-1)
· Follow-up Recommendations (FOLL-A)
· Principles of Surgery (SURG-A)
· Radiation Techniques (RAD-A)
· Principles of Systemic Therapy (CHEM-A)
· Principles of Nutrition: Management and Supportive Care (NUTR-A)
· Principles of Dental Evaluation and Management (DENT-A)

Clinical Trials: NCCN believes that
the best management for any cancer
patient is in a clinical trial.
Participation in clinical trials is
especially encouraged.
To find clinical trials online at NCCN
Member Institutions, click here:
nccn.org/clinical_trials/physician.html.
NCCN Categories of Evidence and

Consensus: All recommendations
are category 2A unless otherwise
specified.
See NCCN Categories of Evidence
and Consensus.

Staging (ST-1)
®

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 NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical
circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representations or
warranties of any kind regarding their content, use or application 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 NCCN. ©2015.
Version 1.2015, 05/12/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

Printed by Anupam Desai on 8/29/2015 11:09:18 PM. For personal use only. Not approved for distribution. Copyright © 2015 National Comprehensive Cancer Network, Inc., All Rights Reserved.

NCCN Guidelines Version 1.2015 Updates
Head and Neck Cancers

NCCN Guidelines Index
Head and Neck Table of Contents
Discussion

Updates in Version 1.2015 of the NCCN Guidelines for Head and Neck Cancer from Version 2.2014 include:
Global Changes
· Footnote for all cancer sites regarding smoking cessation support and resources revised to include a link to the “NCCN Guidelines for
Smoking Cessation.”
· Footnote for all cancer sites regarding adverse risk features was revised: “Adverse features: extracapsular nodal spread, positive margins,
pT3 or pT4 primary, N2 or N3 nodal disease, perineural invasion, vascular embolism (lymphovascular invasion) (See Discussion).”
· Under “Clinical Staging”: A new pathway for “Metastatic (M1) disease at initial presentation” was added for most cancer sites.
· The term “chemotherapy/RT” changed to “systemic therapy/RT” in the algorithm and footnotes for most cancer sites.
Cancer of the Oral Cavity
OR-2
· T1-2, N0; Treatment of Primary and Neck: Wording revised, “No positive nodes and No adverse features.”
OR-3
· T3, N0; T1-3, N1-3; T4a, Any N: The “Adjuvant Treatment” recommendation for N0, N1, N2a-b, N3 was revised, “Consider RT (optional).”
Cancer of the Oropharynx
ORPH-1
· Workup: Second bullet revised, “Biopsy of primary site or FNA of the neck.”
· Footnote regarding PET-CT was removed: “Anatomical imaging is also recommended.”
ORPH-A 1 of 2 Principles of Radiation Therapy
· Definitive; Planning target volume (PTV); Under “High risk” a new fractionation was added, “69.96 Gy (2.12 Gy/fraction) daily Monday–Friday
in 6–7 weeks.” (Also for HYPO-A, NASO-A)
· Footnote “3” is new: “Lee NY, Zhang Q, Pfister DG, et al. Addition of bevacizumab to standard chemoradiation for locoregionally advanced
nasopharyngeal carcinoma (RTOG 0615): a phase 2 multi-institutional trial. Lancet Oncol 2012;13:172-180.”
(Also for HYPO-A, NASO-A)

Cancer of the Hypopharynx
HYPO-1
· Workup: Second bullet revised, “Biopsy of primary site or FNA of the neck.”
HYPO-5
· T4a, any N; Treatment of Primary and Neck: After “Surgery + neck dissection (preferred)” recommendations were added for adjuvant
treatment.
· Footnote “h” added to the page: “Adverse features: extracapsular nodal spread, positive margins, pT3 or pT4 primary, N2 or N3 nodal
disease, perineural invasion, vascular embolism (lymphovascular invasion) (See Discussion).”
HYPO-6
· This is a new page that provides “Response Assessment” recommendations after treatment with induction chemotherapy for stage T4a, any
N.
Version 1.2015, 05/12/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

Continued UPDATES
1 of 5

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NCCN Guidelines Version 1.2015 Updates
Head and Neck Cancers

NCCN Guidelines Index
Head and Neck Table of Contents
Discussion

Cancer of the Nasopharynx
NASO-1
· Workup:
> Second bullet revised: “Nasopharyngeal fiberoptic examination and biopsy.”
· The following bullets were added:
7 Biopsy of primary site or FNA of the neck
7 Consider EBV/DNA testing
7 Consider opthalmologic and endocrine evaluation as clinically indicated.
NASO-2
· Footnote regarding adjuvant chemotherapy removed: “When using concurrent chemotherapy/RT, the preferred agent is cisplatin (category
1). See Principles of Systemic Therapy (CHEM-A).”
NASO-A Principles of Radiation Therapy
· Definitive; PTV; High risk: RT dose revised, “66 Gy (2.2 Gy/fraction) to 70–70.2 Gy (1.8–2.0 Gy/fraction); daily Monday–Friday in 6–7 weeks.”
· Concurrent Chemoradiation; PTV, High risk: RT dose revised, “typically 70–70.2 Gy (1.8–2.0 Gy/fraction); daily Monday–Friday in 7 weeks.”
· Footnote “3” was added: For doses >70 Gy, some clinicians feel that the fractionation should be slightly modified (eg, <2.0 Gy/fraction for at
least some of the treatment) to minimize toxicity. An additional 2-3 doses can be added depending on clinical circumstances.
Cancer of the Glottic Larynx
GLOT-1
· Workup; Second bullet revised, “Biopsy of primary site or FNA of the neck.”
· Clinical Staging: Wording revised, “Amenable to larynx-preserving (conservation) surgery) (T1-T2, N0 or Select T3).” (Also for GLOT-2)
· Footnote “a” revised: “Complete workup is may not be indicated for Tis, T1, but history and physical examination, direct laryngoscopy, and
biopsy under anesthesia are required. “
GLOT-2
· Amenable to larynx-preserving (conservation) surgery) (T1-T2 or Select T3); Treatment of Primary and Neck: Recommendation revised,
“Partial laryngectomy/endoscopic or open resection as indicated or neck dissection as indicated.”
GLOT-3
· T3 requiring (amenable to) total laryngectomy (N0-1); Surgery; N1: Recommendation revised, “Laryngectomy with ipsilateral thyroidectomy
as indicated...”
Cancer of the Supraglottic Larynx
SUPRA-1
· Workup; Second bullet revised, “Biopsy of primary site or FNA of the neck.”
SUPRA-2
· Amenable to larynx-preserving (conservation) surgery (Most T1-2, N0; Selected T3 patients); Pathology Stage: Recommendation revised,
“Positive node; Adverse features: positive margins or other risk features.”
· Footnote “k” is new to the page: “Adverse features: extracapsular nodal spread, positive margins, pT3 or pT4 primary, N2 or N3 nodal
disease, perineural invasion, and vascular embolism (lymphovascular invasion) (See Discussion).”
Continued UPDATES
Version 1.2015, 05/12/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN®.
2 of 5
®

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NCCN Guidelines Version 1.2015 Updates
Head and Neck Cancers

NCCN Guidelines Index
Head and Neck Table of Contents
Discussion

Ethmoid Sinus Tumors
ETHM-1
· Workup: Second bullet revised, “CT or MRI skull base through thoracic inlet.”
· Pathology: Fifth bullet revised, “Undifferentiated carcinoma (sinonasal undifferentiated carcinoma [SNUC], small cell, or sinonasal
neuroendocrine carcinoma [SNEC]).”
· Footnote “e” revised: “For sinonasal undifferentiated carcinoma (SNUC), and small cell or sinonasal neuroendocrine carcinoma (SNEC)
histologies, systemic therapy should be a part of the overall treatment. Consider referral to a major medical center that specializes in these
diseases.”
ETHM-2
· Footnote “f” is new to the algorithm: “N+ neck disease is uncommon in ethmoid cancers, but, if present, requires neck dissection and
appropriate risk-based adjuvant therapy.”
ETHM-A Principles of Radiation Therapy (Also for MAXI-A)
· Definitive; PTV; High risk: RT dose revised, “66 Gy (2.2 Gy/fraction) to 70–70.2 Gy (1.8–2.0 Gy/fraction); daily Monday–Friday in 6–7 weeks.”
· Concurrent Chemoradiation; PTV, High risk: RT dose revised, “typically 70–70.2 Gy (1.8–2.0 Gy/fraction); daily Monday–Friday in 7 weeks.”
Maxillary Sinus Tumors
MAXI-1
· Workup: New bullet added, “Consider PET/CT for Stage III or IV.”
· Pathology; Fifth bullet revised, “Undifferentiated carcinoma (sinonasal undifferentiated carcinoma [SNUC], small cell, or sinonasal
neuroendocrine carcinoma [SNEC]).”
· Footnote “f” revised: “For sinonasal undifferentiated carcinoma (SNUC), and small cell or sinonasal neuroendocrine carcinoma (SNEC)
histologies, and systemic therapy should be a part of the overall treatment. Consider referral to a major medical center that specializes in
these diseases.”
ADV-1 Very Advanced Head and Neck Cancer
· This section was extensively revised including adding treatment recommendations for “Metastatic (M1) disease at initial presentation” and
“Recurrent or persistent disease with distant metastases.”

Version 1.2015, 05/12/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

Continued UPDATES
3 of 5

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NCCN Guidelines Version 1.2015 Updates
Head and Neck Cancers

NCCN Guidelines Index
Head and Neck Table of Contents
Discussion

Occult Primary
OCC-1
· Neck mass; Second column: Second bullet revised, “Complete head and neck exam with attention to skin; palpation of the base of tongue
and oropharynx;...”
· Workup; “Squamous cell carcinoma....” pathway: Fifth bullet under workup revised, “Thyroglobulin, calcitonin, PAX8, and/or TTF staining for
adenocarcinoma...”
OCC-2
· Footnote regarding lingual tonsillectomy removed: “Enrollment in a clinical trial to determine the efficacy of lingual tonsillectomy is strongly
encouraged to assess patient outcomes.”
OCC-3
· Definitive treatment; Surgery (preferred < N2 disease); After “Neck dissection” the node designations, “N1 without extracapsular spread or
N2, N3 without extracapsular spread, or Extracapsular spread” were removed.
Salivary Gland Tumors
SALI-2
· T3, T4a: After “Surgical evaluation” the “Benign” pathway was removed.
· Footnote “f” is new to the algorithm: “If incidental N+ disease is present, go to SALI-3.”
SALI-3
· Footnote “j” revised: “The facial nerve should be preserved if possible; strongly consider referral to a specialized center with reconstructive
expertise.”
SALI-A Principles of Radiation Therapy
· Definitive (RT Alone)
> First bullet revised: “Photon or photon/electron therapy or neutron therapy highly conformal radiation therapy techniques.”
> PTV; High risk: Under “Fractionation” RT dose revised, “66 Gy (2.0 Gy/fraction) to 70–70.2 Gy (1.8–2.0 Gy/fraction); daily Monday–Friday in
6–7 weeks or 19.2 nGy (1.2 nGy/fraction)
> PTV; Low to intermediate risk; Sites of suspected subclinical spread: RT recommendation revised, “44–50 Gy (2.0 Gy/fraction) to 54–63 Gy
(1.6–1.8 Gy/fraction) or 13.2 nGy (1.2 nGy/fraction).”
· Postoperative (RT)
> Second bullet revised: “Photon or photon/electron therapy or neutron therapy.”
> PTV; High risk: Adverse features such as positive margins: RT recommendation revised, “60–66 Gy (2.0 Gy/fraction); daily Monday–Friday
in 6–7 weeks or 18 nGy (1.2 nGy/fraction)
> PTV; Low to intermediate risk; Sites of suspected subclinical spread: RT recommendation revised, “44–50 Gy (2.0 Gy/fraction) to
54–63 Gy (1.6–1.8 Gy/fraction) or 13.2 nGy (1.2 nGy/fraction).”

Version 1.2015, 05/12/15 © National Comprehensive Cancer Network, Inc. 2015, All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

Continued UPDATES
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NCCN Guidelines Version 1.2015 Updates
Head and Neck Cancers
Mucosal Melanoma
MM-2
· Second column: Wording clarified, “Stage IVA, T4a, N0” and “Stage
IVA, T3-T4a, N1.”
MM-4
· After “Nodal basin,” recommendation revised, “Appropriate Nodal
disssection.”
MM-A Principles of Radiation Therapy
· Footnote “2” revised: “For recurrences in nodal basin after previous
surgery, Optional dose schedules include 48–50 Gy
(2.4–3.0 Gy/fraction) and 30–36 Gy (6 Gy/fraction).”

NCCN Guidelines Index
Head and Neck Table of Contents
Discussion

RAD-A Radiation Techniques
2 of 3
> Palliative Radiation; Second bullet; Fifth sub-arrow bullet revised:
“44.4 Gy in 12 fractions, in 3 cycles (for each cycle, give 2 fractions
six hours apart for 2 days in a row, and treatments must exclude the
spinal cord after second cycle). Reassessment should be done at 1to 3-week intervals.”
3 of 3
· New reference added: “Corry J, Peters LJ, Costa ID, et al. The 'QUAD
SHOT'--a phase II study of palliative radiotherapy for incurable head
and neck cancer. Radiother Oncol 2005;77:137-142.”

FOLL-A Follow-up Recommendations
CHEM-A Principles of Systemic Therapy
1 of 5
· Second bullet revised: “Further reimaging as indicated based on
· Squamous cell cancers; Nasopharynx: The second recommendation
signs/symptoms; not routinely recommended for patients without
was revised for clarity, “Cisplatin + RT without adjuvant chemotherapy
worrisome signs/symptoms. Further reimaging as indicated based
(category 2B).”
on worrisome or equivocal signs/symptoms, smoking history, and
2 of 5
areas inaccessible to clinical examination.
· Recurrent, unresectable, or metastatic (incurable);
· Three new bullets added:
> The following single agents were removed as treatment options:
> “Due to the inaccessibility of the nasopharynx, routine annual
Ifosfamide and bleomycin.
imaging may be indicated
> Nutritional evaluation and rehabilitation as clinically indicated until
DENT-A Principles of Dental Evaluation and Management
nutritional status is stabilized
2 of 4
> Ongoing surveillance for depression (See NCCN Guidelines for
· Under “Goals of Dental Management Post-treatment: A new
Distress Management).”
recommendation was added, “Consultation with treating radiation
oncologist is recommended before considering implants or
SURG-A Principles of Surgery
8 of 9 Post Chemoradiation or RT Neck Evaluation
extraction.”
· Persistent disease or progression pathway: Under “To assess extent
of disease or distant metastases,” first bullet revised, “Consider CT
of primary site and neck and/or MRI with contrast (4–8 weeks).”
· “Lymph node <1 cm; PET/CT positive” pathway: The
recommendations are now the same as those “Lymph node >1 cm;
PET/CT negative” Previously the recommendations were: “Individual
decision: Observe or Neck dissection; Consider ultrasound FNA.”

®

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Continued UPDATES
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