NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Head and Neck Cancers Version 1.2018 — February 15, 2018 NCCN.org Continue Version 1.2018, 02/15/18 © National Comprehensive Cancer Network, Inc. 2018, 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 Anton Kabakov on 3/5/2018 6:52:58 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 1.2018 Panel Members NCCN Guidelines Index Table of Contents Head and Neck Cancers Discussion * David G. Pfister, MD † Þ/Chair Robert L. Foote, MD § John A. Ridge, MD, PhD ¶ Memorial Sloan Kettering Cancer Center Mayo Clinic Cancer Center Fox Chase Cancer Center * Sharon Spencer, MD §/Vice-Chair Jill Gilbert, MD † James Rocco, MD, PhD ¶ University of Alabama at Birmingham Vanderbilt-Ingram Cancer Center The Ohio State University Comprehensive Comprehensive Cancer Center Cancer Center - James Cancer Hospital Maura L. Gillison, MD, PhD † and Solove Research Institute David Adelstein, MD † The University of Texas Case Comprehensive Cancer Center/ MD Anderson Cancer Center Cristina P. Rodriguez, MD † University Hospitals Seidman Cancer Center and Fred Hutchinson Cancer Research Center/ Cleveland Clinic Taussig Cancer Institute Robert I. Haddad, MD † Seattle Cancer Care Alliance Dana-Farber/Brigham and Women’s Cancer Center Douglas Adkins, MD † Jatin P. Shah, MD, PhD ¶ Siteman Cancer Center at Barnes-Jewish Hospital Wesley L. Hicks, Jr., MD ¶ Memorial Sloan Kettering Cancer Center and Washington University School of Medicine Roswell Park Cancer Institute Randal S. Weber, MD ¶ David M. Brizel, MD § Ying J. Hitchcock, MD † § The University of Texas Duke Cancer Institute Huntsman Cancer Institute MD Anderson Cancer Center at the University of Utah Barbara Burtness, MD † Matthew Witek, MD § Yale Cancer Center/Smilow Cancer Hospital Antonio Jimeno, MD, PhD † University of Wisconsin University of Colorado Cancer Center Carbone Cancer Center Paul M. Busse, MD, PhD § Massachusetts General Hospital Cancer Center Debra Leizman, MD Þ Frank Worden, MD † Case Comprehensive Cancer Center/ University of Michigan Jimmy J. Caudell, MD, PhD § University Hospitals Seidman Cancer Center and Comprehensive Cancer Center Moffitt Cancer Center Cleveland Clinic Taussig Cancer Institute Sue S. Yom, MD, PhD § Anthony J. Cmelak, MD § Ellie Maghami, MD ¶ ξ UCSF Helen Diller Family Vanderbilt-Ingram Cancer Center City of Hope Comprehensive Cancer Center Comprehensive Cancer Center A. Dimitrios Colevas, MD † Loren K. Mell, MD § Weining Zhen, MD § Stanford Cancer Institute UC San Diego Moores Cancer Center Fred & Pamela Buffett Cancer Center David W. Eisele, MD ¶ Bharat B. Mittal, MD § The Sidney Kimmel Comprehensive Robert H. Lurie Comprehensive Cancer NCCN Cancer Center at Johns Hopkins Center of Northwestern University Jennifer Burns Susan Darlow, PhD Moon Fenton, MD, PhD † Harlan A. Pinto, MD † Þ The University of Tennessee Stanford Cancer Institute Health Science Center † Medical oncology ¶ Surgery/Surgical oncology Continue § Radiation oncology ξ Otolaryngology Þ Internal medicine NCCN Guidelines Panel Disclosures * Discussion Writing Committee Member Version 1.2018, 02/15/18 © National Comprehensive Cancer Network, Inc. 2018, 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 Anton Kabakov on 3/5/2018 6:52:58 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 1.2018 Subcommittees NCCN Guidelines Index Table of Contents Head and Neck Cancers Discussion Principles of Radiation Therapy Principles of Systemic Therapy Principles of Surgery Sharon Spencer, MD §/Lead David G. Pfister, MD † Þ/Lead Randal S. Weber, MD ¶/Lead University of Alabama at Birmingham Memorial Sloan Kettering Cancer Center The University of Texas Comprehensive Cancer Center MD Anderson Cancer Center A. Dimitrios Colevas, MD † David Brizel, MD § Stanford Cancer Institute David M. Brizel, MD § Duke Cancer Institute Duke Cancer Institute Robert I. Haddad, MD † Paul M. Busse, MD, PhD § Dana-Farber/Brigham and Women’s David W. Eisele, MD ¶ Massachusetts General Hospital Cancer Center The Sidney Kimmel Comprehensive Cancer Center Cancer Center at Johns Hopkins Frank Worden, MD † Jimmy J. Caudell, MD, PhD § University of Michigan John A. Ridge, MD, PhD ¶ Moffitt Cancer Center Comprehensive Cancer Center Fox Chase Cancer Center Anthony J. Cmelak, MD § Vanderbilt-Ingram Cancer Center Ying J. Hitchcock, MD † § Mucosal Melanoma Principles of Nutrition Huntsman Cancer Institute A. Dimitrios Colevas, MD †/Lead at the University of Utah Jatin P. Shah, MD, PhD ¶ Memorial Sloan Kettering Cancer Center Stanford Cancer Institute Loren K. Mell, MD § Paul M. Busse, MD, PhD § UC San Diego Moores Cancer Center Massachusetts General Hospital Cancer Center Bharat B. Mittal, MD § Robert H. Lurie Comprehensive Cancer Principles of Dental Evaluation and Management Ying J. Hitchcock, MD § Center of Northwestern University Frank Worden, MD † Huntsman Cancer Institute University of Michigan at the University of Utah Sue S. Yom, MD, PhD § Comprehensive Cancer Center UCSF Helen Diller Family Comprehensive Cancer Center † Medical oncology ¶ Surgery/Surgical oncology § Radiation oncology Continue ξ Otolaryngology NCCN Guidelines Panel Disclosures Þ Internal medicine Version 1.2018, 02/15/18 © National Comprehensive Cancer Network, Inc. 2018, 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 Anton Kabakov on 3/5/2018 6:52:58 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 1.2018 Table of Contents NCCN Guidelines Index Table of Contents Head and Neck Cancers Discussion NCCN Head Neck Cancers Panel Members Clinical Trials: NCCN believes that NCCN Head and Cancers Sub-Committee Members the best management for any patient Summary of the Guidelines Updates with cancer is in a clinical trial. Multidisciplinary Team and Support Services (TEAM-1) Participation in clinical trials is Cancer of the Lip (LIP-1) especially encouraged. Cancer of the Oral Cavity (OR-1) To find clinical trials online at NCCN Cancer of the Oropharynx (ORPH-1) Member Institutions, click here: • p16-negative (ORPH-2) nccn.org/clinical_trials/physician.html. • p16 (HPV)-positive (ORPHPV-1) NCCN Categories of Evidence and Cancer of the Hypopharynx (HYPO-1) Consensus: All recommendations Cancer of the Nasopharynx (NASO-1) are category 2A unless otherwise Cancer of the Glottic Larynx (GLOT-1) indicated. Cancer of the Supraglottic Larynx (SUPRA-1) See NCCN Categories of Evidence Ethmoid Sinus Tumors (ETHM-1) and Consensus. 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) 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. ©2018. Version 1.2018, 02/15/18 © National Comprehensive Cancer Network, Inc. 2018, 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 Anton Kabakov on 3/5/2018 6:52:58 AM. For personal use only. Not approved for distribution. Copyright © 2018 National Comprehensive Cancer Network, Inc., All Rights Reserved. NCCN Guidelines Version 1.2018 Updates NCCN Guidelines Index Table of Contents Head and Neck Cancers Discussion Updates in Version 1.2018 of the NCCN Guidelines for Head and Neck Cancers from Version 2.2017 include: Global Changes Cancer of the Oral Cavity • The term "extracapsular spread" has been changed to "extranodal OR-2 extension." • First and second primary therapy options combined: "Resection • "Multimodality clinical trials" has been changed to "clinical trials." of primary (preferred) ± ipsilateral (guided by tumor thickness) or • "Lymphovascular invasion" has been changed to "vascular/ bilateral (guided by location of primary) neck dissection or SLN lymphatic invasion." biopsy" • For those with positive margins after resection, the adjuvant • Adjuvant therapy revised