Abstract：
OBJECTIVE: To develop consensus on patient characteristics and disease-related factors considered in deciding treatment approaches for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) based on real-world treatment patterns in 4 territories in Asia-Pacific.
METHODS: A three-round modified Delphi involving a multidisciplinary panel of HN surgeons, medical oncologists, and radiation oncologists was used. Of 41 panelists recruited, responses of 26 from Australia, Japan, Singapore, and Taiwan were analyzed. All panelists had ≥five years\' experience managing LA-HNSCC patients and treated ≥15 patients with LA-HNSCC annually.
RESULTS: All statements on definitions of LA-HNSCC, treatment intolerance and cisplatin dosing reached consensus. 4 of 7 statements on unresectability, 2 of 4 on adjuvant chemoradiotherapy, 7 of 13 on induction chemotherapy, 1 of 8 on absolute contraindications and 7 of 11 on relative contraindications to high-dose cisplatin did not reach consensus. In all territories except Taiwan, high-dose cisplatin was preferred in definitive and adjuvant settings for patients with no contraindications to cisplatin; weekly cisplatin (40 mg/m2) preferred for patients with relative contraindications to high-dose cisplatin. For Taiwan, the main treatment option was weekly cisplatin. For patients with absolute contraindications to cisplatin, carboplatin ± 5-fluorouracil or radiotherapy alone were preferred alternatives in both definitive and adjuvant settings.
CONCLUSIONS: This multidisciplinary consensus provides insights into management of LA-HNSCC in Asia-Pacific based on patient- and disease-related factors that guide selection of treatment modality and systemic treatment. Despite strong consensus on use of cisplatin-based regimens, areas of non-consensus showed that variability in practice exists where there is limited evidence.
METHODS: A three-round modified Delphi involving a multidisciplinary panel of HN surgeons, medical oncologists, and radiation oncologists was used. Of 41 panelists recruited, responses of 26 from Australia, Japan, Singapore, and Taiwan were analyzed. All panelists had ≥five years\' experience managing LA-HNSCC patients and treated ≥15 patients with LA-HNSCC annually.
RESULTS: All statements on definitions of LA-HNSCC, treatment intolerance and cisplatin dosing reached consensus. 4 of 7 statements on unresectability, 2 of 4 on adjuvant chemoradiotherapy, 7 of 13 on induction chemotherapy, 1 of 8 on absolute contraindications and 7 of 11 on relative contraindications to high-dose cisplatin did not reach consensus. In all territories except Taiwan, high-dose cisplatin was preferred in definitive and adjuvant settings for patients with no contraindications to cisplatin; weekly cisplatin (40 mg/m2) preferred for patients with relative contraindications to high-dose cisplatin. For Taiwan, the main treatment option was weekly cisplatin. For patients with absolute contraindications to cisplatin, carboplatin ± 5-fluorouracil or radiotherapy alone were preferred alternatives in both definitive and adjuvant settings.
CONCLUSIONS: This multidisciplinary consensus provides insights into management of LA-HNSCC in Asia-Pacific based on patient- and disease-related factors that guide selection of treatment modality and systemic treatment. Despite strong consensus on use of cisplatin-based regimens, areas of non-consensus showed that variability in practice exists where there is limited evidence.
摘要：
目的：根据亚太地区4个地区的实际治疗模式，就决定局部晚期头颈部鳞状细胞癌（LA-HNSCC）治疗方法的患者特征和疾病相关因素达成共识。
方法：由HN外科医生组成的多学科小组组成的三轮改良Delphi，医学肿瘤学家,和放射肿瘤学家被使用。在招募的41名小组成员中，来自澳大利亚的26个回复，Japan,新加坡,对台湾进行了分析。所有小组成员管理LA-HNSCC患者的经验≥5年，每年治疗LA-HNSCC患者≥15例。
结果：关于LA-HNSCC定义的所有陈述，治疗不耐受和顺铂给药达成共识。关于不可切除性的7个陈述中的4个，辅助放化疗的4个中的2个，诱导化疗13个中的7个，8个中的1个关于高剂量顺铂的绝对禁忌症，11个中的7个关于高剂量顺铂的相对禁忌症未达成共识。在除台湾以外的所有领土上，对于没有顺铂禁忌症的患者,大剂量顺铂在确定性和辅助治疗中是首选;对于有高剂量顺铂禁忌症的患者,每周一次顺铂(40mg/m2)是首选.对于台湾来说，主要治疗选择是每周一次顺铂.对于顺铂绝对禁忌症的患者，卡铂±5-氟尿嘧啶或单纯放疗是确定性和辅助治疗的首选方案.
结论：这项多学科共识提供了基于患者和疾病相关因素的亚太地区LA-HNSCC管理的见解，这些因素指导了治疗方式和系统治疗的选择。尽管在使用以顺铂为基础的方案方面达成了强烈共识，非共识领域表明，在证据有限的情况下，实践中存在差异。
方法：由HN外科医生组成的多学科小组组成的三轮改良Delphi，医学肿瘤学家,和放射肿瘤学家被使用。在招募的41名小组成员中，来自澳大利亚的26个回复，Japan,新加坡,对台湾进行了分析。所有小组成员管理LA-HNSCC患者的经验≥5年，每年治疗LA-HNSCC患者≥15例。
结果：关于LA-HNSCC定义的所有陈述，治疗不耐受和顺铂给药达成共识。关于不可切除性的7个陈述中的4个，辅助放化疗的4个中的2个，诱导化疗13个中的7个，8个中的1个关于高剂量顺铂的绝对禁忌症，11个中的7个关于高剂量顺铂的相对禁忌症未达成共识。在除台湾以外的所有领土上，对于没有顺铂禁忌症的患者,大剂量顺铂在确定性和辅助治疗中是首选;对于有高剂量顺铂禁忌症的患者,每周一次顺铂(40mg/m2)是首选.对于台湾来说，主要治疗选择是每周一次顺铂.对于顺铂绝对禁忌症的患者，卡铂±5-氟尿嘧啶或单纯放疗是确定性和辅助治疗的首选方案.
结论：这项多学科共识提供了基于患者和疾病相关因素的亚太地区LA-HNSCC管理的见解，这些因素指导了治疗方式和系统治疗的选择。尽管在使用以顺铂为基础的方案方面达成了强烈共识，非共识领域表明，在证据有限的情况下，实践中存在差异。
