1. HEAD and NECK CANCERS
Elshami Elamin, MD

2. MULTIDISCIPLINARY TEAM
Head and neck surgery
Radiation oncology
Medical oncology
Plastic and reconstructive surgery
Specialized nursing care
Dentistry/prosthodontics
Physical medicine and rehabilitation
Speech and swallowing therapy
Clinical Social work
Nutrition support
Pathology
Diagnostic radiology
Adjunctive services
Neurosurgery
Ophthalmology
Psychiatry
Addiction Services

3. SUPPORT AND SERVICES Pain and symptom management Nutritional support:
Enteral feeding
Dental care for RT effects
Oral supplements
Xerostomia management
Smoking cessation
Tracheotomy care
Social work and Case management
Supportive Care

4. Lymphatic drainage of the head and neck and associated sites of primary tumors Lymphatic drainage
Level I
Submental: Lower lip, chin, anterior oral cavity (including anterior one-third of the tongue and floor of the mouth)
Submandibular: Upper and lower lips, oral tongue, floor of the mouth, facial skin
Level II
Oral cavity and pharynx (including soft palate, base of the tongue, and piriform sinus)
Level III
Larynx, hypopharynx, and thyroid
Level IV
Larynx, hypopharynx, thyroid, cervical esophagus, and trachea
Level V
Nasopharynx, thyroid, paranasal sinuses, and posterior scalp
Supraclavicular: Infraclavicular sites (including lungs, esophagus, breasts, pancreas, GI tract, GU and gynecologic sources)

5. Ethmoid Sinus Tumors Squamous cell carcinoma
Undifferentiated carcinoma
Adenocarcinoma
Salivary gland tumor
Esthesioneuroblastomas
Sarcoma (nonrhabdomyosarcoma)

6. Ethmoid Sinus Tumors Treatment
T1, T2:
Complete surgical resection (preferred) or
Adj RT or Chemo/RT if adverse characteristics (positive margins and perineural invasion)
Definitive RT
T3, T4 resectable:
Complete surgical resection
Postoperative RT
Unresectable:
Chemo/RT or
RT or
Clinical trial (preferred)

7. Ethmoid Sinus Tumors Treatment
Incomplete excision (eg, polypectomy, endoscopic procedure)
Gross residual disease:
Surgery (preferred), if feasible
Adj RT
RT or
Chemo/RT
No disease on physical exam, imaging, and/or endoscopy:
Surgery, if feasible

8. Maxillary Sinus Tumors
Squamous cell carcinoma
Undifferentiated carcinoma
Adenocarcinoma
Salivary gland tumor
Esthesioneuroblastoma
Sarcoma (nonrhabdomyosarcoma)

9. Maxillary Sinus Tumors Treatment
T1, N0 (all histologies): Complete surgical resection:
Margin –ve:
Observe
Perineural invasion:
Consider RT or
chemo/RT
Margin +ve:
reresection
Margin –ve  RT
Margin +ve  chemo/RT
T2, N0 (SCC, Undifferentiated):
Complete surgical resection:
Margin -ve  Consider RT
Perineural invasion  Consider RT or chemo/RT
Margin +ve  reresection
T2, N0 (Adenoidcystic, other histologies)
Complete surgical resection  RT

10. Maxillary Sinus Tumors
T3, N0, Operable T4 (all histologies):
Complete surgical resection:
Adverse characteristics:
Chemo/RT to primary and neck
No adverse characteristics:
RT to primary and neck (SCC and undifferentiated)
T4, inoperable (all histologies):
Clinical trial or
Definitive RT or
Chemo/RT
Any T, N+, resectable:
Surgical excision + neck dissection:
RT to primary and neck

11. Maxillary Sinus Tumors PRINCIPLES OF RT
Definitive RT:
Primary and gross adenopathy:
> 66 Gy
Neck:
Low-risk nodal stations:
> 50 Gy
Postoperative RT:
Primary:
> 60 Gy
Neck
High-risk nodal stations:

12. Salivary Gland Tumors (Parotid, Submaxillary, Minor salivary)
Characteristics of benign tumor:
Mobile superficial lobe
Slow growth
Painless
VII intact
No neck nodes.

13. Salivary Gland Tumors (Parotid, Submaxillary, Minor salivary)
Untreated resectable: clinically benign (< 4 cm: T1, T2):
Complete surgical excision:
Benign or low G  Observe
Adenoid cystic  RT to tumor bed and skull base
Intermediate or high G  RT to tumor bed and ips neck
Untreated resectable, clinically Suspicious (> 4 cm or deep lobe):
CT/MRI base of skull to clavicle  FNA (salivary tumor):
Surgical resection:
Benign  Observe
Cancer see treatment

14. PAROTID GLAND Superficial lobe: Deep lobe: Node –ve: Node +ve:
Parotidectomy
Node +ve:
Parotidectomy + neck dissection
Deep lobe:
Total parotidectomy
Total parotidectomy + neck dissection

15. PAROTID GLAND Completely excised:
No adverse characteristics
Observe
Adverse characteristics (Intermediate or high G, adenoid cystic, Close or +ve margins, neural/perineural invasion, Lymphatic/ vascular invasion, LN mets)
Adj RT or Consider Chemo/RT
Incompletely excised, gross residual disease (No further surgical resection possible):
Definitive RT or Chemo/RT

16. Other salivary gland tumors
Complete excision +/- LN dissection:
No adverse characteristics:
Observe
Adverse characteristics (Intermediate or high G, adenoid cystic, Close or +ve margins, neural/perineural invasion, Lymphatic/ vascular invasion, LN mets)
Adj RT or Consider Chemo/RT

17. Salivary Gland Tumors (Parotid, Submaxillary, Minor salivary)
Previously treated incompletely resected:
Negative P/E and imaging:
Adj RT
Gross residual disease:
Surgical resection, if possible:
No surgical resection possible:
Definitive RT or Chemo/RT
Not resectable:
FNA or open biopsy

18. F/U Physical exam: Chest imaging as clinically indicated
Year 1 q 1–3 m
Year 2, q 2–4 m
Years 3–5 q 4–6 m
> 5 years q 6–12 m
Chest imaging as clinically indicated
TSH every 6-12 m if neck irradiated
CT scan/MRI- baseline

19. Salivary Gland Tumors Recurrence
Locoregional or distant, Resectable:
Surgery + selected metastasectomy  RT
Locoregional, Not resectable:
RT or
Chemo/RT or
Chemotherapy or
Best supportive care

20. Salivary Gland Tumors PRINCIPLES OF RADIATION THERAPY
Definitive RT:
Unresectable or gross residual disease:
Photon/electron therapy or neutron therapy
Primary and gross adenopathy:
> 70 Gy or
19.2 nGy
Low-risk nodal stations:
45-54 Gy or
13.2 nGy
Postoperative RT:
Primary:
> 60 Gy or
18 nGy
Neck:

21. Cancer of the Lip T1–2, N0: Resectable T3, T4, N0 and any T, N1-3:
Surgery or RT
Resectable T3, T4, N0 and any T, N1-3:
Surgery  Adj RT +/- Chemo if high risk or
RT or Chemo/RT if not surgical candidate
Unresectable:
RT or Chemo/RT or best supportive care

22. Cancer of the Oral Cavity (Buccal mucosa, floor of mouth, anterior tongue, alveolar ridge, retromolar trigone, hard palate)
H&P
Biopsy
Chest x-ray or Chest CT
As indicated for evaluation:
Panorex
CT/MRI
Examination under anesthesia
Preanesthesia studies
Dental evaluation
Multidisciplinary consultation as indicated

23. Cancer of the Oral Cavity
T1–2, N0:-
RT  salvage surgery for residual dz OR
excision of primary ± unilateral or bilateral selective neck dissection  adj RT +/-chemo (high risk pts);
High Risk:- Extracapsular nodal dz, +ve margins, multiple +ve LN or perineural/lymphatic/vascular invasion.
Resectable T3, N0:
Excision of primary and reconstruction + unilateral or bilateral selective neck dissection;
Adj RT (optional)
High Risk: Adj RT +/- chemo

24. Cancer of the Oral Cavity (Resectable T1-3, N1-3)
N1, N2a-b, N3:
Excision of primary, ipsi comprehensive neck dissection ± contra selective neck dissection
N2c (bilateral):
Excision of primary and bilateral comprehensive neck dissection
Adj Therapy:
RT (optional)
High Risk; RT +/- chemo

25. Cancer of the Oral Cavity
Resectable T4, Any N:
Surgery (preferred for bone invasion) Chemo/RT or
Chemo/RT  Surgery for residual dz (primary or LN)

26. Cancer of the Oropharynx (Base of tongue/tonsil/posterior pharyngeal wall/soft palate)
H&P
Biopsy
Chest x-ray or Chest CT
CT with contrast or MRI recommended for primary and neck
Panorex as indicated
Dental evaluation as indicated
Speech & swallowing evaluation as indicated
Examination under anesthesia with laryngoscopy
Preanesthesia studies
Multidisciplinary consultation as indicated

27. Cancer of the Oropharynx T1-2, N0-1
Definitive RT (preferred) :
surgery for residual dz
Concurrent chemo/RT (T1-T2, N1 only):
Excision of primary ± unilateral or bilateral neck dissection:
One +ve node without adverse features:
Consider RT
Adverse features:
RT or Chemo/RT (multiple +ve nodes only)

28. Cancer of the Oropharynx T3-4, N0
Concurrent chemo/RT (preferred):
Salvage surgery if residual dz
Surgery + RT:
RT +/- Chemo if high risk or adverse features
Induction chemo followed by chemo/RT off protocol:
Multimodality clinical trial

29. Cancer of the Oropharynx any T3-4, N+ or any T, N2-3
Concurrent chemo/RT (preferred): or
Induction chemo followed by chemo/RT off protocol:
Residual Primary tumor:
Salvage surgery + neck dissection as indicated
Residual neck mass Neck dissection
CR but initial N2-3;
Observe or Neck dissection
OR --- 

30. Cancer of the Oropharynx any T3-4, N+ or any T, N2-3
Surgery: primary and neck:
N1, N2a–b, N3;
Excision of primary, ipsi neck dissection
N2c;
Excision of primary and bilateral neck dissection
Adj RT or Chemo/RT
Multimodality clinical trial

31. PRINCIPLES OF RT Conventional fractionation: 70 Gy (2 Gy/d) in 7 wks
Altered fractionation: 72 Gy/6 weeks (1.8 Gy/d, 1.5 Gy/d boost daily during last 12 treatment days)
Hyperfractionation: 81.6 Gy/7 weeks (1.2 Gy bid)
Primary and gross adenopathy
> 70 Gy (2 Gy/d)
Neck
Low risk: Gy (2 Gy/d)
Postoperative RT:
Primary: 60 Gy (2 Gy/d)
High-risk: 60 Gy (2 Gy/d)
Low-risk:50 Gy (2 Gy/d)
Concurrent Therapy: Conventional RT + Cisplatin 100 mg/m q 3 wk
Use of other fraction sizes and multiagent chemotherapy, has been evaluated with no consensus on the optimal approach.

32. Cancer of the Oral Cavity Oropharynx F/U
Physical exam:
Year 1, every 1-3 m
Year 2, every 2-4 m
Years 3-5, every 4-6 m
> 5 yr, every 6-12 m
Chest imaging as clinically indicated
TSH every 6-12 m, if neck irradiated
Speech and swallowing evaluation and rehabilitation as indicated

33. Hypopharynx (laryngopharynx) entrance to the esophagus Work-up
H&P
Biopsy
Chest x-ray or Chest CT
CT with contrast or MRI of primary and neck
Examination under anesthesia with laryngoscopy and esophagoscopy
Preanesthesia studies
Dental evaluation
Multidisciplinary consultation as indicated

34. Cancer of the Hypopharynx
Early T stage not requiring total laryngectomy:
Most T1, N0-1
Small T2, N0
Resectable advanced cancer requiring total laryngectomy:
T1, N2-3
T2-4, Any N
Participation in clinical is preferred
Unresectable

35. Surgery: Partial laryngopharyngectomy +
Early T stage (not requiring total laryngectomy) Most T1, N0-1, small T2, N0
Definitive RT:
Neck dissection (selective vs comprehensive) if residual dz
Surgery: Partial laryngopharyngectomy +
Ipsi or bilateral selective neck dissection (N0)
Comprehensive neck dissection levels 1-5 (N1)
Adj RT or Chemo/RT if adverse features:
Extracapsular nodal spread
+ve margins
Multiple +ve nodes
Perineural/lymphatic/vascular invasion

36. T1, N2-3; T2-3, any N (if total laryngectomy required)
Induction chemotherapy x 2 cycles:
CR of primary site:
Definitive RT:
Residual neck mass  Neck dissection
CR of neck  if initial N2-3 Observe or neck dissection
PR of primary site:
Chemo x 1 cycle:
CR of primary  definitive RT
Residual primary  savage surgery;
RT or chemoRT depending on adverse features
Less than PR of primary:
Surgery:

37. T1, N2-3; T2-3, any N (if total laryngectomy required)
Laryngopharyngectomy + selective (N0) or comprehensive (N+) neck dissection
Adj RT or ChemoRT depends on adverse features
Concurrent chemoRT:
CR of primary;
Residual neck mass  Neck dissection
CR of neck  if initial N2-3 observe or neck dissection
PR of primary;
Salvage surgery + neck dissection as indicated
Multimodality clinical trial

38. Hypopharynx T4, any N Surgery + comprehensive neck dissection
Chemo/RT
Concurrent chemo/RT:
CR of primary:
Residual neck mass  Neck dissection
CR of neck; N1  observe
if initial N2-3  observe or neck dissection
PR of primary:
Salvage surgery + neck dissection as indicated
Multimodality clinical trial

39. Hypopharynx PRINCIPLES OF RADIATION THERAPY
Definitive RT
Primary and gross adenopathy:
> 70 Gy (2 Gy/d)
Neck; low risk > 50 Gy (2 Gy/d)
Postoperative RT:
Primary: > 60 Gy (2 Gy/d)
Neck;
high-risk > 60 Gy (2 Gy/d)
Low-risk > 50 Gy (2 Gy/d)
Postoperative chemoRT for high risk:
Concurrent Cisplatin 100 mg/m q 3 wks

40. Occult Primary Neck mass  FNA SCC Adenocarcinoma
Anaplastic Epithelial tumors
WORK-up
Complete head and neck exam with attention to skin, including nasopharyngoscopy
Chest x-ray
CT or MRI (skull base through thoracic inlet)
PET scan
Examination under anesthesia
Direct laryngoscopy and nasopharynx survey
If level IV, lower V nodes:
Bronchoscopy, EGD
Chest/abdominal/pelvic CT

41. Occult Primary (NO primary found)
Adenocarcinoma (levels I–III):
Comprehensive neck dissection + parotidectomy, if indicated
RT to neck ± parotid bed
SCC:
Comprehensive neck dissection
N1  Adj RT
Extracapsular spread or N2, N3  RT or ChemoRT
Poorly diff or nonkeratinizing SCC or NOS or Anaplastic (Not thyroid) :
Comprehensive neck dissect  Adj RT +/- chemo or
RT or Chemo RT
Residual dz  Comprehensive neck dissect

42. Cancer of the Glottic Larynx work-up
H&P
Biopsy
Chest x-ray or Chest CT
CT with contrast and thin cuts through larynx, or
MRI of primary and neck
Examination under anesthesia with laryngoscopy
Preanesthesia studies
Dental evaluation as indicated
Speech & swallowing evaluation as indicated
Multidisciplinary consultation as indicated

43. Glottic Larynx Severe dysplasia/CIS
Clinical trial or
Endoscopic removal (stripping/laser) or RT

44. Glottic Larynx Total laryngectomy not required (Most T1-2, any N)
RT to primary > 66 Gy or
Partial laryngectomy/endoscopic resection (selected superficial lesions) or
Open partial laryngectomy
N-ve  observe
N+ve  Neck dissection and/or RT

45. Glottic Larynx Resectable requiring total laryngectomy Most T3, any N
Concurrent chemoradiation:
Primary and neck CR observe
if initial N2-3 Observe or neck dissection
Primary CR, neck PR  Neck dissection
Primary PR  Salvage surgery + neck dissection as indicated

46. Glottic Larynx Resectable requiring total laryngectomy Most T3, any N
Surgery:
N0:-
Laryngectomy with ipsi thyroidectomy +/- unilat or bilateral selective neck dissection
N1:-
Laryngectomy with ipsi thyroidectomy, ipsi comprehensive neck dissection ± contral selective neck dissection
N2-3:-
Laryngectomy with ipsi thyroidectomy, ipsi or bilateral comprehensive neck dissection
Adj Therapy:
If adverse features: (Extracapsular nodal spread +ve margins, multiple +ve LN or perineural/lymphovascular invasion)
Adj RT +/- chemo

47. Glottic Larynx T4 Selected T4: Consider concurrent chemoRT or
Clinical trial for function preserving
Primary and neck CR observe
if initial N2-3 Observe or neck dissection
Primary CR, neck PR  Neck dissection
Primary PR  Salvage surgery + neck dissection as indicated

48. Glottic Larynx T4, Any N N0:- N1:- N2-3:- Adj chemo/RT
Laryngectomy with ipsi thyroidectomy +/- unilat or bilateral selective neck dissection
N1:-
Laryngectomy with ipsi thyroidectomy, ipsi comprehensive neck dissection ± contral selective neck dissection
N2-3:-
Laryngectomy with ipsi thyroidectomy, ipsi or bilateral comprehensive neck dissection
Adj chemo/RT

49. Glottic Larynx PRINCIPLES OF RADIATION THERAPY
Definitive RT
Primary and gross adenopathy:
> 70 Gy (2 Gy/d)
For early cancer of the glottic larynx, preferred dose is 2 Gy/d with total dose modification accordingly
Neck
Low-risk: > 50 Gy (2 Gy/d)
Postoperative RT
Primary: > 60 Gy (2 Gy/d)
High-risk: > 60 Gy (2 Gy/d)
Low-risk > 50 Gy (2.0 Gy/day)
Postoperative chemoradiation for high pathologic risk features:
Concurrent Cisplatin at 100 mg/m q 3 wks

50. Glottic Larynx F/U Physical exam:
Year 1, every 1-3 m
Year 2, every 2-4 m
Years 3-5, every 4-6 m
> 5 years, every 6-12 m
Chest imaging as clinically indicated
TSH every 6-12 m, if neck irradiated
Speech and swallowing evaluation and rehabilitation as indicated

51. Supraglottic Larynx Resectable not requiring total laryngectomy Most T1–2, N0
Endoscopic resection ± selective neck dissection or
Open partial supraglottic laryngectomy ± selective neck dissection or
Definitive RT
Adj Therapy:-
One +ve LN without other adverse features
Consider RT
Adverse features: (+ve margins or extracapsular nodal)
ChemoRT

52. Supraglottic Larynx Resectable requiring laryngectomy (T3, N0; T4, N0) (No cartilage destruction, low-volume base-of tongue involvement)
Laryngectomy, ipsi thyroidectomy + ipsi or bilateral selective neck dissection
N0 or one +ve LN without adverse features
RT optional
Adverse features
RT or chemoRT
Concurrent chemoRT:
Primary site PR:
Salvage surgery + neck dissection as indicated

53. Supraglottic Larynx Resectable T4, N0 Skin involvement, high-volume invasion of base of tongue; cartilage destruction
Laryngectomy, ipsi thyroidectomy + ipsi or bilateral selective neck dissection
Adj RT or chemoRT
Or Cclinical trial

54. Supraglottic Larynx Node positive disease
H&P
Biopsy
Chest x-ray or Chest CT
CT with contrast and thin cuts through larynx or
MRI of primary and neck recommended
Examination under anesthesia with laryngoscopy
Dental evaluation as indicated
Speech & swallowing evaluation as indicated
Multidisciplinary consultation as indicated

55. Supraglottic Larynx (N+ve) CLINICAL STAGING
1- Resectable; Not requiring total laryngectomy (T1–2, N+ and selected T3–4)
2- Resectable; Requiring total laryngectomy (Most T3–4, N+):
Low-volume base-oftongue involvement
No cartilage destruction
3- High-volume T4, N+:
Cartilage destruction
Skin involvement
High-volume invasion of base of tongue
4- Unresectable

56. Supraglottic Larynx Resectable; Not requiring total laryngectomy (T1–2, N+ and selected T3–4)
Definitive RT or
Concurrent chemoRT:
Primary site CR:
Residual neck mass  Neck dissection
CR of neck  Observe or Neck dissection if initial N2-3
Primary site; residual tumor:
Salvage surgery + neck dissection as indicated
Or Partial supraglottic laryngectomy and comprehensive neck dissection:
Observe or RT+/-Chemo if adverse features

57. Supraglottic Larynx Resectable; Requiring total laryngectomy (Most T3–4, N+)
Laryngectomy, ipsi thyroidectomy with comprehensive neck dissection:
No adverse features  Adj RT
Adverse features  Adj RT+/-Chemo
Or Concurrent chemoRT (preferred)
Primary site CR:
Residual neck mass  Neck dissection
CR of neck  Observe or Neck dissection if initial N2-3
Primary site; residual tumor:
Salvage surgery + neck dissection as indicated

58. Supraglottic Larynx High-volume T4, N+
Laryngectomy, ipsi thyroidectomy with ipsi or bilateral neck dissection or
Clinical trial
Adj ChemoRT

59. Supraglottic Larynx PRINCIPLES OF RADIATION THERAPY
Definitive RT:
Primary and gross adenopathy:
> 70 Gy (2 Gy/day)
Neck (Low-risk):
> 50 Gy (2 Gy/day)
Postoperative RT:
Primary:
> 60 Gy (2 Gy/day)
Neck (High-risk):
Neck (Low-risk)
Postoperative chemoRT for high pathologic risk features:
Concurrent single agent Cisplatin 100 mg/m q 3 wks

60. Cancer of the Nasopharynx WORKUP
H&P
Nasopharyngeal exam and biopsy
Chest x-ray or Chest CT
MRI with gadolinium of nasopharynx and base of skull to clavicles and/or CT with contrast
Dental evaluation as indicated
Speech & swallowing evaluation as indicated
Imaging for distant metastases (chest, liver, bones) for N2-3 disease (PET scan and/or CT)
Multidisciplinary consultation

61. Cancer of the Nasopharynx T1, N0, M0 T2a, N0, M0
Definitive RT to nasopharynx
Elective RT to neck

62. Cancer of the Nasopharynx T1, N1-3; T2b-T4, any N
Concurrent ChemoRT:
Cis 100 mg/m on d 1, 22, 43
RT ( 70 Gy) to primary and gross nodal dz
Bilateral neck > 50 Gy
Then
Cis 80 mg/m d FU 1,000 mg/m CI x 4 d repeat every 4 wk x 3
Neck: CR  Observe
Neck: residual dz  Neck dissection

63. Cancer of the Nasopharynx Any T, any N, M1
Platinum-based combination chemo
If CR:
Definitive RT to primary and neck

64. Cancer of the Nasopharynx FOLLOW-UP
Physical exam:
Year 1, every 1–3 mo
Year 2, every 2–4 mo
Year 3–5, every 4–6 mo
> 5 years, 6–12 mo
TSH every 6-12 mo, if neck irradiated
Speech and swallowing evaluation and rehabilitation as indicated

65. Unresectable Head and Neck Ca M0; T4b, any N; or Unresectable N+
Clinical trial (preferred)
PS 0-1:
Concurrent Cis or Carbo-based chemo + RT or
Induction chemo followed by RT
Residual neck disease:
Neck dissection, if feasible + primary site controlled
PS 2:
Induction chemo followed by RT or
Definitive RT
PS 3:
Definitive RT or
Best supportive care

66. Recurrent Head and Neck Cancer
Locoregional recurr without prior RT:
Resectable
Surgery +/- RT
Unresectable
Locoregional recurr or 2nd primary with prior RT:
Surgery ± reirradiation
clinical trial preferred
Reirradiation
Chemotherapy or
Distant mets:
Clinical trial preferred
PS 0–1
Combination chemo or Single-agent chemo
PS 2
Single agent chemo or Best supportive care
PS 3
Best supportive care

67. PRINCIPLES OF CHEMOTHERAPY (SCC: Maxillary Sinus, Ethmoid Sinus, Lip, Oral Cavity, Oropharynx, Hypopharynx, Glottic larynx, Supraglottic larynx, Occult Primary)
Primary ChemoRT:
Cisplatin alone
5-FU/hydroxyurea
Cis/Taxol
Cis/5-FU
Carbo/5-FU
Postoperative Chemoradiation:
Induction chemo (followed by chemoRT):
Carbo/Taxol
Docetaxel/cisplatin/5-FU

68. PRINCIPLES OF CHEMOTHERAPY Nasopharynx
ChemoRT followed by adj chemo
Cis + RT followed by Cis/5-FU

69. PRINCIPLES OF CHEMOTHERAPY Unresectable Recurrent Head and Neck Cancers
Combination therapy
Cis or carbo + 5-FU
Cis or carbo + taxane
Cis/cetuximab
Single agent
Cisplatin
Carboplatin
Paclitaxel
Docetaxel
5-FU
Methotrexate
Ifosfamide
Bleomycin
Gemcitabine (nasopharyngeal)
Cetuximab

70. THANKS