[Analysis of treatment practices for locally advanced head and neck squamous cell carcinoma: A survey from GORTEC]

The management of locally advanced head and neck tumors is complex due to the multimodal nature of the treatment and the frequent presence of comorbidities in this patient population. International guidelines recommend the use of cisplatin concomitantly with radiotherapy; however, its administration is often limited by contraindications and potential toxicities. The management of treatment-related adverse effects, as well as the use of induction chemotherapy, remains heterogeneous. Therefore, we aimed to assess the current practices of French oncologists in order to identify potential needs and evaluate the relevance of issuing national recommendations to harmonize clinical practice.

We performed a descriptive study using an online questionnaire comprising 57 items, distributed to the member centers of the Groupe d'oncologie radiothérapie des cancers de la tête et du cou (GORTEC). The survey addressed three main topics: concomitant systemic therapy, management of cetuximab-related toxicities, and neoadjuvant treatment strategies.

A total of 32 responses were collected. For definitive treatment settings, more than 50% of patients received concomitant therapy, most commonly cisplatin at 100mg/m² every 3 weeks. In adjuvant settings, more than 50% of patients received concomitant therapy in half the centers and less than 50% in the others, predominantly weekly cisplatin at 40mg/m². Target delineation was primarily based on a geo-anatomical approach. Forty percent of centers offered prophylactic photobiomodulation. Induction chemotherapy was used occasionally in 47% of centers, mainly for laryngeal preservation.

Current clinical practices in France show moderate variability. While the gold standard remains widely applied, our study highlights the challenges of implementing it in the real-world, for whom therapeutic adaptations are often required.