Primary Chemoradiation
- Fundamental Principle is that all patients who are
surgical candidates should undergo primary surgical resection as
outlined above.
- p16 Positive Squamous Cell Carcinoma of the Oropharynx
The recommendation is to proceed with standard cisplatin-based
chemoradiation with the caveat that there should be shared informed
decision-making between the clinician and the patient of the risks
versus the benefits of adding cytotoxic chemotherapy to the treatment
regimen during the COVID-19 pandemic.
p16 Negative Squamous Cell Carcinoma
The recommendation is to consider systemic-therapy sensitized
radiation. Registry data indicate that cetuximab is inferior to
cisplatin regardless of primary site, but this needs to be weighed
against the desire to minimize the immunosuppression associated with
cytotoxic chemotherapy.19 There should thus be
shared informed decision-making between the clinician and the patient
of the risks versus the benefits of substituting cetuximab for
cisplatin in the treatment regimen during the COVID-19 pandemic.
- When Possible Avoid : TPF (docetaxel, cisplatin, and
5-fluorouracil) regimens for induction therapy, as they are associated
with high rates of neutropenic fever and subsequent hospitalization.
- When Possible Avoid : For chemoradiation patients, try
to avoid high-dose cisplatin, which can result in higher rates of
hospitalization and renal dysfunction. Instead, substitute weekly
cisplatin at 40 mg/m2.20