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Open AccessReview

New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era

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Department of Oncology and Radiotherapy, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
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C.F. Clinical Hospital, 700506 Iași, Romania
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County Clinical Emergency Hospital Craiova, 200642 Craiova, Romania
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Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
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National Institute of Research and Development for Technical Physics, 700050 Iaşi, Romania
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“Prof. Dr. Nicolae Oblu” Emergency Clinic Hospital, 700309 Iaşi, Romania
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Department of Oral Pathology, Gr. T. Popa, University of Medicine and Pharmacy, 700115 Iaşi, Romania
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Department of Clinical Laboratory, St. Spiridon, Emergency Hospital, 700111 Iaşi, Romania
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Department of Oncology and Radiotherapy, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania
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Regional Institute of Oncology, 700483 Iaşi, Romania
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Author to whom correspondence should be addressed.
Academic Editor: Alexandre Bozec
J. Clin. Med. 2021, 10(4), 587; https://doi.org/10.3390/jcm10040587
Received: 28 December 2020 / Revised: 25 January 2021 / Accepted: 28 January 2021 / Published: 4 February 2021
(This article belongs to the Special Issue Advances in the Multi-Disciplinary Treatment of Head and Neck Cancer)
Locally advanced head and neck cancer is a unique challenge for cancer management in the Covid-19 situation. The negative consequences of delaying radio-chemotherapy treatment make it necessary to prioritize these patients, the continuation of radiotherapy being indicated even if SARS-CoV-2 infection is confirmed in the case of patients with moderate and mild symptoms. For an early scenario, the standard chemo-radiotherapy using simultaneous integrated boost (SIB) technique is the preferred option, because it reduces the overall treatment time. For a late scenario with limited resources, hypo-fractionated treatment, with possible omission of chemotherapy for elderly patients and for those who have comorbidities, is recommended. Concurrent chemotherapy is controversial for dose values >2.4 Gy per fraction. The implementation of hypo-fractionated regimens should be based on a careful assessment of dose-volume constraints for organs at risks (OARs), using recommendations from clinical trials or dose conversion based on the linear-quadratic (LQ) model. Induction chemotherapy is not considered the optimal solution in this situation because of the risk of immunosuppression even though in selected groups of patients TPF regimen may bring benefits. Although the MACH-NC meta-analysis of chemotherapy in head and neck cancers did not demonstrate the superiority of induction chemotherapy over concurrent chemoradiotherapy, an induction regimen could be considered for cases with an increased risk of metastasis even in the case of a possible Covid-19 pandemic scenario. View Full-Text
Keywords: head and neck cancer; non-surgical; radiotherapy; chemotherapy; Covid-19 head and neck cancer; non-surgical; radiotherapy; chemotherapy; Covid-19
MDPI and ACS Style

Mireștean, C.C.; Crișan, A.; Mitrea, A.; Buzea, C.; Iancu, R.I.; Iancu, D.P.T. New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era. J. Clin. Med. 2021, 10, 587. https://doi.org/10.3390/jcm10040587

AMA Style

Mireștean CC, Crișan A, Mitrea A, Buzea C, Iancu RI, Iancu DPT. New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era. Journal of Clinical Medicine. 2021; 10(4):587. https://doi.org/10.3390/jcm10040587

Chicago/Turabian Style

Mireștean, Camil C.; Crișan, Anda; Mitrea, Adina; Buzea, Călin; Iancu, Roxana I.; Iancu, Dragoș P.T. 2021. "New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era" J. Clin. Med. 10, no. 4: 587. https://doi.org/10.3390/jcm10040587

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Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

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