H&N Controversies

This page is meant to discuss the evidence in the treatment of Head and Neck cancers, the practical issues associated with the implementation of the same and the controversies thereof. Members are encouraged to post their views and opinions so that all may benefit.

Neoadjuvant Chemotherapy in Head and Neck cancer

One of the burning issues in the management of Head and Neck cancers is Neoadjuvant Chemotherapy in the Management of Head and Neck cancers. There are several sub-issues in this:

  1. What is the exact role of Neoadjuvant Chemotherapy in the management of Head and Neck Cancers? Do all patients need it and benefit from it?
  2. What agents are to be used and which one are to foregone?
  3. How best to sequence and deliver Chemotherapy?
  4. What should be the target volumes in post Chemotherapy?
  5. When and how to assess response?
  6. How should toxicities be managed?
  7. What should be done for the patient who has a poor response or progression?
  8. Who pays for the additional cost?

Click here for the complete discussion and to add your own opinion for the benefit of all

Contour Changes in Head and Neck Cancer

The RO world is agog with IGRT and "adaptive" radiotherapy. There are two problems:

  1. by far the largest cause of variation is the voluming undertaken by the radiation oncologist (as a case in point, we are having a Pinnacle Users Group meeting soon and there is the obligatory test case. The CTV to PTV expansion is 8mm!
  2. by far the second largest unknown is the contour changes that occur over the course of treatment. The manufacturers like to portray their competence in dealing with these problems using CBCT, on-line dose calculations and automated contouring.

Here is a discussion about some underlying questions that bear thinking about before discussing the merits of the additional technology. Click here for the complete discussion, select a question and add your own opinion for the benefit of all.

Transoral Robotic Surgery for Head and Neck Cancer

A discussion on the implications of transoral robotic surgery for head and neck cancer

Is 95 to 95 the benchmark for SIB IMRT?

A discussion on is 95% dose to 95% volume the benchmark for SIB IMRT

When to Reirradiate?

When to re-irradiate a patient with recurrent head and neck Cancer?

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