SIGN H&N Guidelines 2006 Summary

8/7/2019 SIGN H&N Guidelines 2006 Summary

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SIGN H&N Guidelines 2006: Summary

Tumour Rx of primary Rx of N0 neck Rx of N+ neck

Early glottic 1. RT2. conservation surg

none

Early supraglottic 1. RT2. conservation surg

1. RT to LII and III2. surg to LII and III

Bilat if not well lateralised

Locally advanced laryngeal Ca 1. total laryngect and pot-op RT

2. CRT, reserving surg forsalvage

3. RT+cetuximab4. RT alone, modified

fractionation

5. RT to LII to IV6. surg to LII to IV

Bilat if not well lateralised

1. MRND and post-opRT/CRT

2. CRT followed by surg ifresidual dis (N1)

3. CRT followed byplanned ND (N2 or 3)

Include LII to IV

Early hypopharyngeal 1. CRT2. conservative surg +/- post-op RT/CRT3. RT only if unsuitable foroptions 1 or 2

1. RT bilat LII to IV2. surg to LII to IV +/-

post-op RT/CRT

Locally advancedhypopharyngeal Ca

1. CRT2. neo-adjuvant

cisplatin/5FU then RTalone if have completeresponse to chemo

3. surgery +/- post-opRT/CRT

4. RT only if unsuitable foroptions 1, 2or 3

5. If unresectable dis Rx

1. RT bilat LII to IV2. surg to LII to IV +/-

post-op RT/CRT




Include LII to IV


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CRT6. In small primary can

treat neck surgically

then primary and neckwith RT/CRT

Early oropharyngeal Ca 1. Surg + reconstruction +/-post-op RT/CRT2. RT/CRT3. small accessible tumoursconsider brachytherapy + extbeam RT

1. surg LII to IV (or II to V iftongue base) +/- post-opRT/CRT2. RT LII to IV (or II to V iftongue base)If tumour well lateralized treatipsilat neck only.If tongue base or soft palatetreat bilat neck.

Locally advancedoropharyngeal Ca

1. surgery +/- post-opRT/CRT

2. CRT3. RT+cetuximab4. RT alone, modified

fractionation5. In small primary can

treat neck surgicallythen primary and neckwith RT/CRT




Include LII to IV bilat

Early oral cavity Ca 1. surg with rim rather than segmentalresection wherepossible +/- post-opRT/CRT

2. re-resection should beperformed if initialresection margins +ve

1. surg to LI to III +/- post-op RT/CRT

2. RT to LI to III


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3. brachytherapy in well-demarcated lesions

Locally advanced oral cavity

Ca

1. surg +reconstruction +/-

RT/CRT2. CRT if +ve margins, pxunfit for surgery, pxpreference

3. RT + cetuximab4. RT alone, modified

fractionation

1. MRND, bilat if locally

advanced primary,tumour midline ormultiple nodes + bilatRT to levels I to IV

2. where RT to primaryand evidence ofresidual dis give CRT(N1)

3. where RT to primaryand evidence residualdis treat with surg then

planned CRT (N2 or 3)

Notes:

CRT refers to[RT+ cisplatin] each time

Grade A recommendations (at least 1 meta-analysis, systematic review of RCTs, or RCT rated as 1++ or 1+ and directlyapplicable to target population):

Use of concurrent cisplatin with post-op RT in px with extracapsular spread or +ve surgical margins

Rx of primary in locally advanced laryngeal Ca

In px medically unsuitable for cisplatin with RT use cetuximab and RT

In px unsuitable for cisplatin or cetuximab use modified fractionation RT alone

In px with unresectable hypopharyngeal or oral cavity Ca Rx RT+cisplatin

Most other recommendations Grade D (non-analytic studies and expert opinion ie levels 3 and 4 evidence)

Documents

SIGN H&N Guidelines 2006 Summary