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HN cancer - Coggle Diagram

- - - - margins
      - +LVI
      - +PNI
  - - - renal failure
      - hearing loss
    - - HD carboplatin/5FU
      - cetuximab
- - - - seems beneficial in EBV-NPC T4 disease and advanced nodal involvement
- - - - EORTC: stage III, IV, ECS, PNI, tumor embolism
      - RTOG: >2LN, ECS, +margins
    - - cisplatin 100 mg q 3weeks
      - weekly cisplatin 40 mg/m2 seems equivalent
        
        Kiyota ASCO 2020
    - - makes radiation work better
- - - - ORR 18% median OS 12.3m; better than cetuximab+chemo
      - benefit in PD-L1 in CPS >=1
- - - - cetuximab
        
        Bonner trial lancet oncology 2010
        
        trial design - locally advanced disease instead of unresectable
        
        cetuximab SE: rash, diarrhea, infusion reaction
      - RTOG1016 cisplatin/RT vs cetuximab/RT
        
        no difference in mucositis
        
        inferior PFS and OS
      - classification is different based on HPV status
      - cisplatin based chemoradiotx
        
        ~50% pts required feeding tube