How would you manage simultaneous locally advanced NSCLC and locally advanced head and neck cancer?
Would you treat lung and HN at the same time vs sequentially?
Answer from: Radiation Oncologist at Academic Institution
Agree with Dr. @Muayad Almahariq, however, if planning to treat these synchronously, I would favor two setups, one for lung and one for HN. I would want to keep doses in lung tight to minimize toxicity as much as possible. Having to fight with arms and butterfly arcs is going to make that much tough...
Answer from: Radiation Oncologist at Academic Institution
Admittedly, this is an outside-the-box answer, but if the patient has a good performance status, consider treatment with carbo/taxol and concurrent RT to both cancers at the same time. Carbo/taxol is category 1 recommendation for lung ca ChemoRT. It is not first line for HNC ChemoRT, but acceptable ...
Answer from: Radiation Oncologist at Academic Institution
I agree with the considerations noted in the answers above, including individualized assessments of performance status and optimization of supportive care and patient setup. I would add that the terms "locally advanced H+N cancer" and "locally advanced NSCLC" can describe cancers that are quite...
Answer from: Radiation Oncologist at Academic Institution
First, assess the performance status of the patient to determine whether they can receive multimodal curative-intent therapy.
If so, then assay both tumors for actionable mutations and if they exist, proceed with induction systemic therapy for the site that will likely most respond. At the same tim...
Answer from: Radiation Oncologist at Academic Institution
I've had this situation once, but to make matters worse, he had multifocal H&N primaries (soft palate and larynx), but thankfully no cervical nodes. His lung cancer was much more advanced (T4N2 if I remember correctly) so we started with definitive CRT to his lung lesions and I was pleasantly su...