1. Squamous cell carcinoma of the head and neck (SCCHN) General Features and Treatment Guidelines Arafat Tfayli, MD Associate Professor of Clinical Medicine American University of Beirut Medical Center [email_address]

12. Lymph zones of the neck Level I: submental, submandibular Level II: upper jugular Level III: mid jugular Level IV: lower jugular Level V: posterior triangle (including spinal accessory or posterior cervical chain) Level VI: prelaryngeal (Delphian), pretracheal, paratracheal Other groups: sub-occipital retropharyngeal parapharyngeal buccinator (facial) preauricular periparotid intraparotid

18. Figure 2. Human Papillomavirus (HPV) in Oropharyngeal Cancers. Recent studies confirm that oropharyngeal tumors are often HPV-positive and compose a distinct clinical and pathologic disease entity. In Panel A, a typical large tonsillar lesion (arrows) is shown. Panel B shows the typical basaloid appearance often seen in HPV-positive tumors. In Panel C, the same tissue section was subjected to in situ hybridization with an HPV-E7-specific probe. The dark brown spots indicate the presence of HPV DNA in virtually all the neoplastic cells. (Courtesy of Wayne M. Koch and William H. Westra.).

29. Concurrent CRT Is Superior to Radiotherapy Alone in Both the Definitive and Adjuvant Setting Salama et al. JCO VOL 25 NUM 26 SEP 2007

30. Meta-analysis of HNC (MACH-NC) Bourhis J: J Clin Oncol 24:489s, 2004 (suppl; abstr 5505)

31. Salama et al. JCO Vol 25 Num 26 Sep. 10 2007

32. Postoperative irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer Bernier et al: 350:1945-1952, 2004

33. Postoperative irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer NEJM 350:, 2004

34. Epidermal growth factor receptor

36. Erbitux + RT: Locoregional control Hazard ratio=0.68 (95% CI: 0.52–0.89); p=0.005 Time (months) Erbitux + RT (n=211) Locoregional control (%) 100 80 60 40 20 0 0 10 20 30 40 50 60 70 RT (n=213) 14.9 months 24.4 months 47% (3-year control rate) 34% (3-year control rate) Bonner J et al. N Engl J Med 2006;354:567 –578

37. Erbitux + RT: Overall survival 5-year update Bonner J et al. Int J Radiat Oncol Biol Phys 2008; 72 (Suppl):Abs LB3 Hazard ratio=0.73 (95% CI: 0.56–0.95); p=0.018 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 0 10 20 30 40 50 60 70 Time (months) Probability of overall survival 29.3 months 49.0 months Erbitux + RT (n=211) RT (n=213) 36% (5-year survival rate) 46% (5-year survival rate)

39. Concurrent CRT Results in Superior Laryngeal Preservation Compared With Sequential CRT or RT Alone

43. The VA Trial : Conclusion Induction chemotherapy and definitive radiation therapy are effective in preserving the larynx in a high percentage of patients, without compromising overall survival .

47. Concurrent CRT Is Associated With Increased Toxicity compared With RT Alone

50. Late toxicity associated with Concurrent CRT Machtay et al, JCO VOL 26 NUM 21 JULY 20 2008

60. Trials are ongoing to determine the role of induction chemotherapy in the setting of highly active CRT

61. Thank you