Background As proton beam radiation therapy (PBRT) may allow greater normal tissue sparing when compared with intensity-modulated radiation therapy (IMRT), we compared the dosimetry and treatment-related toxicities between patients treated to the ipsilateral head and neck with either PBRT or IMRT. Methods Between 01/2011 and 03/2014, 41 consecutive patients underwent ipsilateral irradiation for major salivary gland cancer or cutaneous squamous cell carcinoma. The availability of PBRT, during this period, resulted in an immediate shift in practice from IMRT to PBRT, without any change in target delineation. Acute toxicities were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Results Twenty-three (56.1%) patients were treated with IMRT and 18 (43.9%) with PBRT. The groups were balanced in terms of baseline, treatment, and target volume characteristics. IMRT plans had a greater median maximum brainstem (29.7 Gy vs. 0.62 Gy (RBE), P < 0.001), maximum spinal cord (36.3 Gy vs. 1.88 Gy (RBE), P < 0.001), mean oral cavity (20.6 Gy vs. 0.94 Gy (RBE), P < 0.001), mean contralateral parotid (1.4 Gy vs. 0.0 Gy (RBE), P < 0.001), and mean contralateral submandibular (4.1 Gy vs. 0.0 Gy (RBE), P < 0.001) dose when compared to PBRT plans. PBRT had significantly lower rates of grade 2 or greater acute dysgeusia (5.6% vs. 65.2%, P < 0.001), mucositis (16.7% vs. 52.2%, P = 0.019), and nausea (11.1% vs. 56.5%, P = 0.003). Conclusions The unique properties of PBRT allow greater normal tissue sparing without sacrificing target coverage when irradiating the ipsilateral head and neck. This dosimetric advantage seemingly translates into lower rates of acute treatment-related toxicity.

Because of the national emergency triggered by the coronavirus disease 2019 (COVID‐19) pandemic, government‐mandated public health directives have drastically changed not only social norms but also the practice of oncologic medicine. Timely head and neck cancer (HNC) treatment must be prioritized, even during emergencies. Because severe acute respiratory syndrome coronavirus 2 predominantly resides in the sinonasal/oral/oropharyngeal tracts, nonessential mucosal procedures are restricted, and HNCs are being triaged toward nonsurgical treatments when cures are comparable. Consequently, radiation utilization will likely increase during this pandemic. Even in radiation oncology, standard in‐person and endoscopic evaluations are being restrained to limit exposure risks and preserve personal protective equipment for other frontline workers. The authors have implemented telemedicine and multidisciplinary conferences to continue to offer standard‐of‐care HNC treatments during this uniquely challenging time. Because of the lack of feasibility data on telemedicine for HNC, they report their early experience at a high‐volume cancer center at the domestic epicenter of the COVID‐19 crisis.

Objective: Limited data is available to guide non-surgical management of Stage T4 larynx and hypopharynx cancer patients who have inoperable disease or refuse surgery. We aim to review the nonoperative management of T4 laryngeal and hypopharyngeal cancer and report the long-term therapeutic and functional outcomes.Methods: We reviewed the nonoperative management of T4 laryngeal (n = 44) and hypopharyngeal (n = 53) cancer from 1997 to 2015 and performed a univariate analysis (UVA).Results: The 2-/5-year OS rates were 73%/38% for larynx patients and 52%/29% for hypopharynx patients. Locoregional failure (LRF) occurred in 25% and 19% of larynx and hypopharynx patients, respectively. On UVA of the larynx subset, N3 nodal status and non-intensity-modulated radiation therapy were negatively associated with OS; treatment with radiation therapy alone impacted disease-free survival; and age >70 was associated with LRF. On UVA of the hypopharynx subset, only T4b status significantly impacted OS. In the larynx and hypopharynx groups, 68% and 85% received a percutaneous endoscopic gastrostomy (PEG) tube and 32% and 40% received a tracheostomy tube, respectively. At the last follow-up visit, 66% of our larynx cohort had neither tracheostomy or PEG placed and 40% of our hypopharynx cohort had neither. Conclusion:We report better than previously noted outcomes among T4 larynx and hypopharynx patients who have unresectable disease or refuse surgery.

Purpose/Objective(s) The COVID-19 pandemic triggered a national emergency which drastically affected the practice of medicine. Studies have already shown that delays in cancer screening/diagnosis/treatment have ensued, and some project this will translate into increased mortality. We aimed to evaluate if early oropharyngeal cancer (OPC) outcomes with radiation therapy (RT) were affected. Materials/Methods On 3/17/2020, in response to the crisis in New York City, telemedicine consultations were implemented at our institution and patients followed prospectively. The Covid cohort (COV) includes new patients through July 2020. They were compared to a contemporary pre-Covid (PC) historical cohort of new patients from November 2019 to 3/16/2020. We reviewed medical records and collected clinicopathologic factors for OPC patients treated with curative intent RT. The Kaplan-Meier method was used to estimate time-to-event outcomes. Results Median follow-up was 8.6 [1.0-13.8] months for all (5.8 months COV, 10.1 months PC). Both cohorts encompassed ∼19 weeks, but half as many consults were seen during the pandemic (n = 38 COV, n = 78 PC). The COV cohort included: 74% telehealth, 92% definitive RT (no surgery), and 89% chemoRT. The PC cohort included: 0% telehealth, 88% definitive RT (no surgery), and 94% chemoRT. There was no difference in COV vs. PC median times from consultation to simulation (1.1 [0-6.4] weeks vs. 1.4 [0-10.6] weeks) or simulation to RT start (2.1 [1.3-4.9] weeks vs. 2.0 [1.1-9.9] weeks). There was no difference in 6 month outcomes between COV vs. PC cohorts: local control (100% vs. 100%, P = 0.70), regional control 100% vs. 100%, P = 0.70), distant control (95.2% vs. 97.2%, P = 0.91), cancer-specific survival (100% vs. 98.7%, P = 0.48). There was no difference in outcomes between telemedicine vs. in-person consults. There were numerically more patients with very advanced disease during the pandemic: T4 (13.2% COV vs. 7.7% PC) or N3/M1 (5.2% COV vs. 2.6% PC), but differences were not statistically significant due to limited numbers. More patients treated during the pandemic developed grade 3 dysphagia requiring feeding tubes (10.5% COV vs. 5.1% PC), not significant due to limited numbers. No patients diagnosed with COVID (1 before, 2 during, and 5 after RT) had recurrence at last follow-up. Conclusion There was no difference in early 6 month outcomes between COV and PC cohorts, no difference in outcomes with telemedicine, and RT delivery was sustained at pre-pandemic timelines. Several important clinical trends were identified in the COV cohort: about half as many consultations were seen during the pandemic, patients appeared more likely to present with very advanced disease, and more patients required feeding tubes during treatment. These findings may have important post-pandemic healthcare de...

High‐dose (HD) cisplatin remains the standard of care with chemoradiation for locally advanced oropharyngeal cancer (OPC). Cooperative group trials mandate bolus‐HD (100 mg/m2 × 1 day, every 3 weeks) cisplatin administration at the beginning of the week to optimize radiosensitization—a requirement which may be unnecessary. This analysis evaluates the impact of chemotherapy administration day of week (DOW) on outcomes. We also report our institutional experience with an alternate dosing schedule, split‐HD (50 mg/m2 × 2 days, every 3 weeks). We retrospectively reviewed 435 definitive chemoradiation OPC patients from 10 December 2001 to 23 December 2014. Those receiving non‐HD cisplatin regimens or induction chemotherapy were excluded. Data collected included DOW, dosing schedule (bolus‐HD vs split‐HD), smoking, total cumulative dose (TCD), stage, Karnofsky Performance Status, human papillomavirus status and creatinine (baseline, peak and posttreatment baseline). Local failure (LF), regional failure (RF), locoregional failure (LRF), distant metastasis (DM), any failure (AF, either LRF or DM) and overall survival (OS) were calculated from radiation therapy start. Median follow‐up was 8.0 years (1.8 months‐17.0 years). DOW, dosing schedule and TCD were not associated with any outcomes in univariable or multivariable regression models. There was no statistically significant difference in creatinine or association with TCD in split‐HD vs bolus‐HD. There was no statistically significant association between DOW and outcomes, suggesting that cisplatin could be administered any day. Split‐HD had no observed differences in outcomes, renal toxicity or TCD compared to bolus‐HD cisplatin. Our data suggest that there is some flexibility of when and how to give HD cisplatin compared to clinical trial mandates.