2016_Head & Neck COURSE BOOK

Summary key points  – 

• Modified fractionation (hyperfractionation and/or acceleration) is superior to conventional fractionation • Hypoxic sensitizers (e.g. nimorazole) improves tumor control and survival without enhancing radiation morbidity • Concomitant platinum‐based chemotherapy is more effective than RT alone for younger patients in  good performance status with and advanced stage tumours. Acute and late toxicity is increased • EGFR inhibition combined with radiotherapy (but not chemoRT) results in enhancement of tumor  response • The optimal combination of these ’radiotherapy intensifiers’ is still unsettled • All of the above in turn needs to be re‐evaluated in the light of the  major impact of HPV on radiation response and prognosis • HPV status needs to be taken into account whenever a clinical trial  is conducted or interpreted (identification, stratification..) • Until such evidence is collected, HPV‐status should not influence  intensity of treatment • De‐escalation trials for HPV+ patients are ongoing • Although there is currently much focus on the HPV‐positive  patients it is important not to forget the HPV negative patients ,    ‐ ,  who have poor prognosis and need better strategies!