10 Chapter 1 institutions [8]. At the Comprehensive Cancer Center of Maastricht University Medical Center (MUMC+) and the Maastro Clinic, the patient is seen during the first consultation by a head and neck surgeon in oral and maxillofacial surgery (OMS), a head and neck surgeon in otolaryngology (ENT) and a head and neck radiation-oncologist. On the same day, the patient is examined by an oral hygienist, a maxillofacial prosthodontist and, if necessary, an anaplastologist. If a biopsy has not yet been performed, it will also be scheduled on the day of the initial consultation. Day 2 is primarily used for imaging, including CT or MRI and ultrasound of the neck. On day 3, the multidisciplinary tumor board (MDT) of the head and neck working group is held, in which the patient is discussed including all the results of the diagnostic tests. The TNM-staging system is used for classification and a proposal for the therapeutic concept is determined based on this [3, 9, 10]. The multidisciplinary team is complemented by plastic surgery, medical oncology, dermatology, oncology nursing care, dietetics, speech therapy, physiotherapy and psychosocial care to achieve structural and functional preservation, improve morbidity when possible and maintain longterm quality of life (QoL) [3]. Following the MDT, the recommended treatment plan is discussed with the patient. For early-stage cancers of the oral cavity and paranasal sinuses, surgery is the treatment of choice with high cure rates and limited morbidity. Early-stage oropharyngeal cancer can be treated by primary surgery or radiotherapy (RT), with RT playing an important role in preserving the larynx in patients with laryngeal cancer [3]. In locally advanced disease, the preferred therapy depends largely on the size and anatomic location of the primary tumor, disease stage, patient age, patient preferences, performance status, and coexisting diseases. For cancer of the oral cavity surgical resection remains the treatment of choice, followed by adjuvant RT, which may be combined with chemotherapy (CRT). At other anatomical sites, surgical resection would likely result in poor longterm functional outcomes, and RT combined with chemotherapy (CRT) is the curative standard of care. CRT is reserved for nonelderly patients who do not have serious comorbidities. RT is usually administered five days per week for seven weeks in fractions of 2Gy up to 66Gy in 33 fractions or 70Gy in 35 fractions in case of postoperative and primary RT, respectively. This is combined with cisplatin administered intravenously every three weeks at a dose of 100 mg/m2 [11, 12]. Cetuximab is considered in patients ineligible for cisplatin and consists of a loading dose of 400 mg/m2 followed by 250 mg/m2 weekly, combined with accelerated fractionated RT up to 68Gy in 34 fractions in 38 days [13].
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