Session Content References

Despite rapid advances in systemic regimens, reirradiation technology, and an expanding pipeline of therapies for recurrent/metastatic HNSCC, we need evidence-based frameworks to select appropriate candidates and plan safe re-irradiation, reassess resectability and coordinate timing of surgery after response to modern chemo-immunotherapy, and stratify and sequence emerging treatments using contemporary trial data and biomarkers. These gaps drive heterogeneous decision making, inconsistent tolerance mitigation, underutilization of clinical trials and variable patient outcomes. Focused education is needed to align day-to-day practice with current evidence and ongoing trials across these domains.

Practicing clinicians need up-to-date understanding of rapidly evolving domains in recurrent/metastatic HNSCC-specifically, modern re-irradiation paradigms, criteria for surgical conversion after systemic response and new systemic options in HPV-negative disease. This activity closes knowledge gaps by synthesizing current evidence and ongoing trials across these topics. Clinicians must translate the latest evidence into day-to-day decisions: for example, selecting candidates for re-irradiation, coordinating timing of salvage surgery after immuno-/chemotherapy response, and integrating emerging therapeutics into individualized care pathways. The planned sessions provide practical, case-focused guidance on when and how to apply these strategies. To improve outcomes, teams need to consistently implement multidisciplinary, evidence-based workflows, such as standardizing toxicity mitigation in re-irradiation, aligning surgical decision making with systemic responses, and ensuring timely adoption of new therapies. This program is structured to drive consistent practice change across these interfaces.

Faculty will walk participants through patient selection criteria for salvage local and systemic therapy, then model pathways that coordinate systemic therapy response with salvage surgery/RT.

Potential Challenges/Barriers to Change:

1. Resource and workflow constraints.
2. Reimbursement/authorization uncertainty for salvage local therapy and combined-modality care.
3. Knowledge diffusion and variability across disciplines (medical oncology, surgery, RT) and sites.

Expected Results:

• Give learners an opportunity to increase their level of knowledge and skills.
• When appropriate, apply new strategies and make practice modifications.

Upon completion of this live activity, attendees should be able to do the following:

1. Create more standardized and evidence-based re-irradiation decisions and plan: apply current selection criteria, consensus OAR limits, and explicit toxicity-mitigation steps.
2. Have a better understanding for evaluating resectability criteria to coordinate salvage surgery/RT.
3. Modernize systemic sequencing and trial integration. Align first/subsequent lines with latest. evidence and document biomarkers; use focused RT when appropriate.

References:

1. EHNS–ESMO–ESTRO Clinical Practice Guideline for squamous cell carcinoma of the head and neck (2020)
2. ESTRO–EORTC consensus on re-irradiation: definition, reporting, and clinical decision-making. Radiother Oncol. 2024
3. KEYNOTE-048 Journal of Clinical Oncology 2023 41:4, 790-802

Virally mediated head and neck cancers caused by the Human Papilloma Virus (HPV) and the Epstein-Barr Virus (EBV) are increasing in the United States and are a global health problem. Understanding emerging treatment paradigms based on the viral etiology of these malignancies is critical to improve disease-control and quality-of-life outcomes in these diseases.

It is imperative that head and neck oncologists (including radiation oncologists, medical oncologists and head and neck surgeons) understand the unique management paradigms specific for virally mediated head and neck cancers. This includes understanding how to use viral testing in the management of each of these diseases and understanding novel therapeutic strategies that target these viral-specific cancers. These technologies are rapidly developing and being implemented into clinical practice, and further information about the state-of-the-art of the field is necessary to inform physicians about these changes.

This session will provide an overview of emerging technologies and treatment paradigms in head and neck cancers driven by the Human Papilloma Virus (HPV) and Epstein-Barr Virus (EBV). In particular, the utility of both EBV and HPV circulating tumor DNA testing will be reviewed in the locoregional and/or metastatic settings. Further, novel immunotherapeutic paradigms targeting these viral-mediated cancers will be discussed.

Potential Challenges/Barriers to Change:

1. The lack of knowledge of how to use these viral tests to make clinical decisions may prevent implementation.
2. The lack of resources may prohibit the ability for participants to enroll patients on novel clinical trials targeting these viral-mediated cancers.
3. Low patient numbers with EBV-mediated cancers in the US may limit the applicability to smaller practice settings.

Expected Results:

• Give learners an opportunity to increase their level of knowledge and skills.
• When appropriate, apply new strategies and make practice modifications.

Upon completion of this live activity, attendees should be able to do the following:

1. Understand the pathogenesis and mechanisms of these virally mediated head and neck cancers.
2. Identify how to use viral DNA to make treatment decisions in localized HPV-mediated oropharyngeal cancer and EBV-mediated nasopharyngeal cancer.
3. Understand novel treatment paradigms targeting the virally-mediated etiology of these cancers in the locoregional and metastatic settings.

References:

1. An international collaboration to harmonize the quantitative plasma Epstein-Barr virus DNA assay for future biomarker-guided trials in nasopharyngeal carcinoma (PMID 23459720)
2. Comparison of next generation sequencing, droplet digital PCR, and quantitative real-time PCR for the earlier detection and quantification of HPV in HPV-positive oropharyngeal cancer (PMID 35334415)
3. A Prospective Trial of Biomarker-Guided Surveillance for HPV-Positive Oropharynx Cancer Using Plasma Tumor Tissue-Modified Viral HPV DNA (PMID 39715483)

Recent data has demonstrated that the doses commonly used for elective nodal irradiation may be higher than what is actually necessary. Higher doses can lead to additional toxicity without any proven clinical benefit. Attendees will be informed about the history of elective nodal irradiation doses, how they have changed during the modern IMRT era, as well as recent data suggesting lower doses may be equally effective. A recent Phase III study demonstrated that lower elective nodal irradiation doses resulted in comparable disease control rates, however less grade 3 dysphagia and improved rates of xerostomia related quality of life.

It is important for oncology professionals to understand the history of elective nodal irradiation, how doses were selected initially as well as the technological limitations of that era. Attendees will also learn how these doses change as the field moved to IMRT with simultaneous integrated boost dosing. Attendees will learn the newest science regarding ENI doses necessary in the modern high resolution CT/MRI/PET based imaging era. Oncologists will learn the latest evidence regarding trials and outcomes with modern lower ENI doses. They will also learn to identify and how to appropriately dose equivocal and borderline lymph nodes to provide.

The talk will cover the history of elective nodal irradiation and how doses were originally selected. Also covered will be how these doses changed as the field moved to IMRT. Failure rates in the elective nodal fields will be examined. Additionally, recent trials and institutional experiences studying lower doses of ENI will be presented. Finally, practitioners will be educated on how to approach borderline or equivocal nodes that do not meet the standard for full dose irradiation.

Potential Challenges/Barriers to Change:

1. Challenges include historical precedent and the hesitation to change practice from how one was trained.
2. There may be concerns about whether these approaches will be formalized into national/international guidelines (ASTRO/ASCO/NCCN/AHNS).
3. Barriers may also include if these approaches will be adopted by cooperative groups sponsoring clinical trials such as ECOG-ACRIN/NRG.

Expected Results:

• Give learners an opportunity to increase their level of knowledge and skills.
• When appropriate, apply new strategies and make practice modifications.

Upon completion of this live activity, attendees should be able to do the following:

1. Understand the history of how current elective nodal irradiation doses were established.
2. Understand the data supporting reduced dose elective nodal irradiation.
3. Understand how to recognize and appropriately dose equivocal lymph nodes.

References:

1. Safavi et al. Principles and Paradigms of De-Escalated Elective Nodal Irradiation: Boldly Going Towards an Inflection Point in Head and Neck Radiotherapy Semin Radiat Oncol. 2025 Apr;35(2):143-156
2. Van den Bosch et al. Clinical Benefit and Safety of Reduced Elective Dose in Definitive Radiotherapy for Head and Neck Squamous Cell Carcinoma: The UPGRADE-RT Multicenter Randomized Controlled Trial. J Clin Oncol. 2025 Apr 15:JCO2402194
3. Sher et al. Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer Int J Radiat Oncol Biol Phys. 2021 Mar 15;109(4):932-940

The management of thyroid cancer is constantly evolving with new guidelines and new therapies available to support patients. Failure to stay informed leads to lower quality of care by practicing clinicians.

It is imperative that the surgeons, medical oncologists and endocrinologists remain current in the state-of-the-art techniques. This two-day meeting provides attendees the opportunity to gain exposure to the latest science in thyroid cancer. Attendees need to determine when and how the latest science will affect their day-to-day practice and thus be able to narrow competency gaps across the work up and the various treatment options for thyroid cancer.

We are planning a panel discussion with experts from head and neck surgery, medical oncology and endocrinology in which we will discuss several relevant topics such as anaplastic cancer, papillary cancer and medullary cancer. We will discuss contemporary workup and treatment options.

Potential Challenges/Barriers to Change:

1. Rapidly changing knowledge and frequent new treatment options.
2. Expense and availability associated with genetic testing in thyroid disease.

Expected Results:

• Give learners an opportunity to increase their level of knowledge and skills.
• When appropriate, apply new strategies and make practice modifications.

Upon completion of this live activity, attendees should be able to do the following:

1. Understand the work up for thyroid nodules and indications for genetic testing.
2. Be aware of the issues associated with GLP-1 drugs and risk for medullary cancer.
3. Triage a patient with anaplastic thyroid cancer into the correct treatment pathway.

There are many ongoing advances in patient safety in the context of radiation therapy delivery, clinical research on treatment options, and advanced techniques in radiotherapy delivery. Failure to stay informed leads to lower quality of care by practicing clinicians.

It is important that surgeons recognize the extent of surgery needed for the primary tumor and cervical lymphatics in upfront management of salivary gland cancer. Attendees need to recognize the emerging role of systemic therapy in management of salivary cancer and determine what molecular markers help guide therapy. Radiation oncologists need to understand indications for adjuvant radiation therapy following surgery for salivary cancer and when the use of specialized radiation approaches such as proton therapy may be indicated.

This will be a case-based tumor board presenting patients with different types of salivary cancer. The goals of the session are to outline the extent of surgery needed in upfront management of salivary cancer, the indications for adjuvant radiation therapy and when special techniques are utilized, and the emerging role of molecular profiling for designing systemic treatment in patients with advanced recurrent/metastatic disease. The cases presented are meant to be the foundation for an open discussion with our panel of experts and there will be an opportunity for audience questions/comments.

Potential Challenges/Barriers to Change:

1. There may be a lack of surgical expertise in management of salivary cancer.
2. Facilities may lack specific radiation therapy equipment such as proton therapy and may lack specialized training in head and neck radiation therapy techniques.
3. Facilities may lack medical oncologists with an understanding of the potential role for targeted therapy based on tumor molecular profiling.

Expected Results:

• Give learners an opportunity to increase their level of knowledge and skills.
• When appropriate, apply new strategies and make practice modifications.

Upon completion of this live activity, attendees should be able to do the following:

1. Recognize the importance of multidisciplinary management of salivary cancer.
2. Appreciate the importance of adequate upfront surgical management of patients with parotid cancer.
3. Determine indications for use of adjuvant radiation therapy in management of salivary cancer and when use of special particles should be considered.
4. Understand the emerging role of molecular testing of salivary tumors to help guide systemic therapy.

References:

1. Wierzbicka M, Napierala J. Updated National Comprehensive Cancer Network guidelines for treatment of head and neck cancers 2010-2017. Otolaryngol Pol. 2017 Dec 30;71(6)
2. Warshavsky A, Rosen R, Muhanna N, Ungar O, Nard-Carmel N, Abergel A, Fliss DM, Horowitz G. Rate of Occult Neck Nodal Metastasis in Parotid Cancer: A Meta-Analysis. Ann Surg Oncol. 2021 Jul;28(7): 3664-3671
3. Bugia L, Jungbauer F, Zaubitzer L, Hörner C, Merx K, Yasser AM, Germann T, Lammert A, Scherl C, Rotter N, Affolter A. Nivolumab as a Promising Treatment Option for Metastatic Salivary Duct Carcinoma. 2024 Sep;47(7):258-262

Technological advances have progressed rapidly, expanding the tools used for monitoring and treatment of patients with head/neck cancer. As these technologies approach clinical deployment it is essential to understand their potential applications.

Emerging technological tools are capable of accomplishing new, clinically applicable tasks. It is imperative to stay apprised of the evolving landscape and be aware of pitfalls of these new tools in applications.

Learners will understand the foundational principles and clinical applications of emerging technologies, including artificial intelligence, in the diagnosis and management of head and neck cancers. Learners will explore ethical, practical and implementation considerations for integrating AI and novel technologies into multidisciplinary head and neck cancer care. Learners will be able to identify application for emerging technology methods in surgery, radiation oncology and medical oncology.

Potential Challenges/Barriers to Change:

1. Lack of knowledge of potential applications.
2. Concern about how emerging technologies work.
3. Lack of access to new technologies.

Expected Results:

• Give learners an opportunity to increase their level of knowledge and skills.
• When appropriate, apply new strategies and make practice modifications.

Upon completion of this live activity, attendees should be able to do the following:

1. Identify applications of emerging technologies in radiation oncology, medical oncology, and surgery.

References:

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC11839013/
2. ASCO 2025 Head/neck poster 490
3. NCT05420948

Skull-based cancers are complex and heterogeneous diseases that require complex multidisciplinary management between head and neck surgeons, medical oncologists and radiation oncologists. Emerging data has given novel insights into the optimal treatment of sinonasal and skull-based malignancies. Failure to keep up to date on emerging data and multidisciplinary considerations leads to worse patient outcomes.

It is critical that physicians that take care of patients with skull-based malignancies are knowledgeable about multidisciplinary considerations for the care of these patients. This session will provide the audience a case-based multidisciplinary discussion about optimal multimodality management of these complex diseases. Participants will understand novel and emerging approaches to skull-based malignancies in terms of role of systemic therapy, response adaptive surgery and novel radiation approaches. Physicians that take care of patients with sinonasal cancers require up to date case-based considerations that result in personalized treatment for patients that optimize survival while minimizing long-term treatment related toxicities.

Multimodality treatment is the cornerstone of skull-based and sinonasal malignancies of the head and neck. These diseases require domain-specific expertise with considerations for systemic therapy, radiation therapy and surgical approaches. Recent emerging data regarding neoadjuvant chemotherapy, organ preserving strategies, and response-adaptive treatment approaches have contributed to the body of evidence that drives optimal multidisciplinary treatment of these diseases. The current activity will use a data-driven, case-based approach to discuss emerging data in the context of multimodality treatment of sinonasal and other skull-based malignancies of the head and neck.

Potential Challenges/Barriers to Change:

1. Lack of multidisciplinary expertise.
2. Challenges in diagnosis and evaluation.
3. Difficulty in coordination of optimal multidisciplinary management and supportive care for these diseases.

Expected Results:

• Give learners an opportunity to increase their level of knowledge and skills.
• When appropriate, apply new strategies and make practice modifications.

Upon completion of this live activity, attendees should be able to do the following:

1. Understand the complex multimodality treatment approaches to sinonasal cancers.
2. Characterize emerging data of neoadjuvant chemotherapy and organ preservation in head and neck malignancies.
3. Discuss considerations of systemic therapy, radiation therapy, and surgery in the context of sinonasal cancers.

References:

1. Saba et al. CCR 2025
2. Resteghini et al. ESMO Open 2025
3. Amit et al. JCO 2019

There are many ongoing clinical trials in head and neck squamous cell carcinoma (HNSCC) that offer potential therapeutic benefits to HNSCC patients. This session will summarize those trials and their results. Failure to stay informed of these clinical advances leads to lower quality of cancer care by practicing oncologists.

Oncologists who treat head and neck squamous cell carcinoma (HNSCC) must understand ongoing clinical trials. This 90-minute session will provide attendees the opportunity to gain exposure to the latest clinical research in HNSCC.

The “Innovations in Action: Emerging Clinical Trials in Head and Neck Cancers” session includes three topics: novel systemic therapy, immunotherapy, and therapy de-escalation. The speakers will summarize the state of the field, preliminary results of ongoing clinical trials in these three areas, and clinical trial design for planned trials. The speakers will also provide scientific rationale for the emerging trials.

Potential Challenges/Barriers to Change:

1. Trial availability
2. Medical insurance coverage
3. Lack of time to implement

Expected Results:

• Give learners an opportunity to increase their level of knowledge and skills.
• When appropriate, apply new strategies and make practice modifications.

Upon completion of this live activity, attendees should be able to do the following:

1. Be aware of the novel systematic strategies for head and neck cancers.
2. Understand that innovative immunotherapy approaches are being tested in head and neck cancers.
3. Recognize that de-escalation of therapy for head and neck cancers may lead to lower long term toxicity.

References:

1. Importance of clinical trials and contributions to contemporary oncology. Doe JD et al. Curr Med Res Opin. 2024 Jan;40(1):45–52
2. Effect of medical oncologists’ attitudes on accrual to clinical trials. Somkin CP et al. Cancer. 2013 Nov;119(21):3866–73