The Care of the HPV-Negative Head and Neck Cancer Patient: Presentation, Prognosis, Treatment

  • Anthony J. CmelakEmail author
  • Eleni Rettig
  • F. Christopher Holsinger
Part of the Head and Neck Cancer Clinics book series (HNCC)


Chaturvedi et al. [1] recently described the population-based estimated incidence of HPV-positive and HPV-negative OPC in the USA using the Surveillance, Epidemiology, and End Results (SEER) database [1]. From 1988 to 2004, HPV-positive OPC increased by 225 % (95 % CI 208 − 242 %; from 0.8 per 100,000 to 2.6 per 100,000), whereas the incidence of HPV-negative cancers declined by 50 % (95 % CI 47 − 53 %; from 2.0 per 100,000 to 1.0 per 100,000). The American Cancer Society estimated that 52,140 new cases of laryngeal, oral and pharyngeal cancers would occur in 2011 [2]. A limitation of these estimates is the difficulty in ascertaining the proportion of ‘oral cavity and pharynx cancers’ that are OPCs per se.


Overall Survival Induction Chemotherapy Radiation Therapy Oncology Group Normal Tissue Complication Probability Transoral Laser Microsurgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011;29:4294–301.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Siegel R, Ward E, Brawley O, et al. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011;61:212–36.PubMedCrossRefGoogle Scholar
  3. 3.
    Ang KK, Harris J, Wheeler R, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2011;363:24–35.CrossRefGoogle Scholar
  4. 4.
    Brizel DM, Albers ME, Fisher SR, et al. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 1998;338:1798–804.PubMedCrossRefGoogle Scholar
  5. 5.
    Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349:2091–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Posner MR, Hershock DM, Blajman CR, et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med. 2007;357:1705–15.PubMedCrossRefGoogle Scholar
  7. 7.
    Kies MS, Holsinger FC, Lee JJ, et al. Induction chemotherapy and cetuximab for locally advanced squamous cell carcinoma of the head and neck: results from a phase II prospective trial. J Clin Oncol. 2010;28:8–14.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamouscell carcinoma of the head and neck. N Engl J Med. 2006;354:567–78.PubMedCrossRefGoogle Scholar
  9. 9.
    Ward GE, Robben JO. A composite operation for radical neck dissection and removal of cancer of the mouth. Cancer. 1951;4:98–109.PubMedCrossRefGoogle Scholar
  10. 10.
    Sugarbaker ED, Gilford J. Combined jaw resection neck dissection for metastatic carcinoma of cervical lymph nodes secondarily involving the mandible. Surg Gynecol Obstet. 1946;83:767–77.PubMedGoogle Scholar
  11. 11.
    Holsinger FC, Weber RS. Swing of the surgical pendulum: a return to surgery for treatment of head and neck cancer in the 21st century? Int J Radiat Oncol Biol Phys. 2007;69:S129–31.PubMedCrossRefGoogle Scholar
  12. 12.
    Holsinger FC, Sweeney AD, Jantharapattana K, et al. The emergence of endoscopic head and neck surgery. Curr Oncol Rep. 2010;12:216–22.PubMedCrossRefGoogle Scholar
  13. 13.
    Steiner W. Experience in endoscopic laser surgery of malignant tumours of the upper aero-digestive tract. Adv Otorhinolaryngol. 1988;39:135–44.PubMedGoogle Scholar
  14. 14.
    Weinstein GS, O’Malley Jr BW, Magnuson JS, et al. Transoral robotic surgery: a multicenter study to assess feasibility, safety, and surgical margins. Laryngoscope. 2012;122:1701–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Strong MS, Jako GJ. Laser surgery in the larynx. Early clinical experience with continuous CO2 laser. Ann Otol Rhinol Laryngol. 1972;81:791–8.PubMedGoogle Scholar
  16. 16.
    Desai SC, Sung CK, Jang DW, et al. Transoral robotic surgery using a carbon dioxide flexible laser for tumors of the upper aerodigestive tract. Laryngoscope. 2008;118:2187–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Solares CA, Strome M. Transoral robot-assisted CO2 laser supraglottic laryngectomy: experimental and clinical data. Laryngoscope. 2007;117:817–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Adelstein DJ, Ridge JA, Brizel DM, et al. Transoral resection of pharyngeal cancer: summary of a National Cancer Institute Head and Neck Cancer Steering Committee Clinical Trials Planning Meeting, 6–7 November 2011, Arlington, Virginia. Head Neck. 2012;34:1681–703.PubMedCrossRefGoogle Scholar
  19. 19.
    Moore EJ, Olsen SM, Laborde RR, et al. Long-term functional and oncologic results of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Mayo Clin Proc. 2012;87:219–25.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Hurtuk AM, Marcinow A, Agrawal A, et al. Quality-of-life outcomes in transoral robotic surgery. Otolaryngol Head Neck Surg. 2012;146:68–73.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Hutcheson KA, Holsinger FC, Kupferman ME, et al. Functional outcomes after TORS for oropharyngeal cancer: a systematic review. Eur Arch Otorhinolaryngol. 2015;272(2):463–71.PubMedCrossRefGoogle Scholar
  22. 22.
    Garden AS, Kies MS, Weber RS. To TORS or Not to TORS: but is that the question? Comment on ‘transoral robotic surgery for advanced oropharyngeal carcinoma’. Arch Otolaryngol Head Neck Surg. 2010;136:1085–7.PubMedCrossRefGoogle Scholar
  23. 23.
    National Comprehensive Cancer Network. Clinical practice guidelines in oncology (NCCN guidelines®) head and neck cancers. Verson 1.2012. Cited 2014; Available from:
  24. 24.
    Dische S, Saunders M, Barrett A, et al. A randomised multicentre trial of CHART versus conventional radiotherapy in head and neck cancer. Radiother Oncol. 1997;44:123–36.PubMedCrossRefGoogle Scholar
  25. 25.
    Waldron J, Warde P, Irish J, et al. A dose escalation study of hyperfractionated accelerated radiation delivered with integrated neck surgery (HARDWINS) for the management of advanced head and neck cancer. Radiother Oncol. 2008;87:173–80.PubMedCrossRefGoogle Scholar
  26. 26.
    Overgaard J, Hansen HS, Specht L, et al. Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6 and 7 randomised controlled trial. Lancet. 2003;362:933–40.PubMedCrossRefGoogle Scholar
  27. 27.
    Dische S, Saunders MI. The CHART regimen and morbidity. Acta Oncol. 1999;38:147–52.PubMedCrossRefGoogle Scholar
  28. 28.
    Fu KK, Pajak TF, Trotti A, et al. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys. 2000;48:7–16.PubMedCrossRefGoogle Scholar
  29. 29.
    Bourhis J, Overgaard J, Audry H, et al. Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis. Lancet. 2006;368:843–54.PubMedCrossRefGoogle Scholar
  30. 30.
    Brahme A. Design principles and clinical possibilities with a new generation of radiation therapy equipment. A review. Acta Oncol. 1987;26:403–12.PubMedCrossRefGoogle Scholar
  31. 31.
    Eisbruch A, Marsh LH, Martel MK, et al. Comprehensive irradiation of head and neck cancer using conformal multisegmental fields: assessment of target coverage and noninvolved tissue sparing. Int J Radiat Oncol Biol Phys. 1998;41:559–68.PubMedCrossRefGoogle Scholar
  32. 32.
    Eisbruch A, Ship JA, Martel MK, et al. Parotid gland sparing in patients undergoing bilateral head and neck irradiation: techniques and early results. Int J Radiat Oncol Biol Phys. 1996;36:469–80.PubMedCrossRefGoogle Scholar
  33. 33.
    Bussels B, Maes A, Flamen P, et al. Dose-response relationships within the parotid gland after radiotherapy for head and neck cancer. Radiother Oncol. 2004;73:297–306.PubMedCrossRefGoogle Scholar
  34. 34.
    Chao KS, Deasy JO, Markman J, et al. A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys. 2001;49:907–16.PubMedCrossRefGoogle Scholar
  35. 35.
    Pow EH, Kwong DL, McMillan AS, et al. Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys. 2006;66:981–91.PubMedCrossRefGoogle Scholar
  36. 36.
    Eisbruch A, Marsh LH, Dawson LA, et al. Recurrences near base of skull after IMRT for head-and-neck cancer: implications for target delineation in high neck and for parotid gland sparing. Int J Radiat Oncol Biol Phys. 2004;59:28–42.PubMedCrossRefGoogle Scholar
  37. 37.
    Sultanem K, Shu HK, Xia P, et al. Three-dimensional intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: The University of California-San Francisco experience. Int J Radiat Oncol Biol Phys. 2000;48:711–22.PubMedCrossRefGoogle Scholar
  38. 38.
    Nutting CM, Morden JP, Harrington KJ, et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol. 2011;12:127–36.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Bhide SA, Harrington KJ, Nutting CM. Otological toxicity after postoperative radiotherapy for parotid tumours. Clin Oncol (R Coll Radiol). 2007;19:77–82.CrossRefGoogle Scholar
  40. 40.
    Anteunis LJ, Wanders SL, Hendriks JJ, et al. A prospective longitudinal study on radiation-induced hearing loss. Am J Surg. 1994;168:408–11.PubMedCrossRefGoogle Scholar
  41. 41.
    Nutting CM, Rowbottom CG, Cosgrove VP, et al. Optimisation of radiotherapy for carcinoma of the parotid gland: a comparison of conventional, three-dimensional conformal, and intensity-modulated techniques. Radiother Oncol. 2001;60:163–72.PubMedCrossRefGoogle Scholar
  42. 42.
    Jereczek-Fossa BA, Orecchia R. Radiotherapy-induced mandibular bone complications. Cancer Treat Rev. 2002;28:65–74.PubMedCrossRefGoogle Scholar
  43. 43.
    Lee IJ, Koom WS, Lee CG, et al. Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys. 2009;75:1084–91.PubMedCrossRefGoogle Scholar
  44. 44.
    Ben-David MA, Diamante M, Radawski JD, et al. Lack of osteoradionecrosis of the mandible after intensity-modulated radiotherapy for head and neck cancer: likely contributions of both dental care and improved dose distributions. Int J Radiat Oncol Biol Phys. 2007;68:396–402.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Studer G, Studer SP, Zwahlen RA, et al. Osteoradionecrosis of the mandible: minimized risk profile following intensity-modulated radiation therapy (IMRT). Strahlenther Onkol. 2006;182:283–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Reuther T, Schuster T, Mende U, et al. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients—a report of a thirty year retrospective review. Int J Oral Maxillofac Surg. 2003;32:289–95.PubMedCrossRefGoogle Scholar
  47. 47.
    Parliament M, Alidrisi M, Munroe M, et al. Implications of radiation dosimetry of the mandible in patients with carcinomas of the oral cavity and nasopharynx treated with intensity modulated radiation therapy. Int J Oral Maxillofac Surg. 2005;34:114–21.PubMedCrossRefGoogle Scholar
  48. 48.
    Montejo ME, Shrieve DC, Bentz BG, et al. IMRT with simultaneous integrated boost and concurrent chemotherapy for locoregionally advanced squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 2011;81:e845–52.PubMedCrossRefGoogle Scholar
  49. 49.
    Nguyen NP, Vock J, Chi A, et al. Effectiveness of intensity-modulated and image-guided radiotherapy to spare the mandible from excessive radiation. Oral Oncol. 2012;48:653–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Mendenhall WM, Amdur RJ, Morris CG, et al. Intensity-modulated radiotherapy for oropharyngeal squamous cell carcinoma. Laryngoscope. 2010;120:2218–22.PubMedCrossRefGoogle Scholar
  51. 51.
    Eisbruch A, Harris J, Garden AS, et al. Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00–22). Int J Radiat Oncol Biol Phys. 2010;76:1333–8.PubMedCentralPubMedCrossRefGoogle Scholar
  52. 52.
    Gomez DR, Zhung JE, Gomez J, et al. Intensity-modulated radiotherapy in postoperative treatment of oral cavity cancers. Int J Radiat Oncol Biol Phys. 2009;73:1096–103.PubMedCrossRefGoogle Scholar
  53. 53.
    Nabil S, Samman N. Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113:54–69.PubMedCrossRefGoogle Scholar
  54. 54.
    Staar S, Rudat V, Stuetzer H, et al. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy—results of a multicentric randomized German trial in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;50:1161–71.PubMedCrossRefGoogle Scholar
  55. 55.
    Budach V, Stuschke M, Budach W, et al. Hyperfractionated accelerated chemoradiation with concurrent fluorouracil-mitomycin is more effective than dose-escalated hyperfractionated accelerated radiation therapy alone in locally advanced head and neck cancer: final results of the radiotherapy cooperative clinical trials group of the German Cancer Society 95–06 Prospective Randomized Trial. J Clin Oncol. 2005;23:1125–35.PubMedCrossRefGoogle Scholar
  56. 56.
    Nguyen NP, Sallah S, Karlsson U, et al. Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues. Cancer. 2002;94:1131–41.PubMedCrossRefGoogle Scholar
  57. 57.
    Levendag PC, Teguh DN, Voet P, et al. Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose-effect relationship. Radiother Oncol. 2007;85:64–73.PubMedCrossRefGoogle Scholar
  58. 58.
    Bhide SA, Gulliford S, Kazi R, et al. Correlation between dose to the pharyngeal constrictors and patient quality of life and late dysphagia following chemo-IMRT for head and neck cancer. Radiother Oncol. 2009;93:539–44.PubMedCrossRefGoogle Scholar
  59. 59.
    Eisbruch A, Schwartz M, Rasch C, et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT? Int J Radiat Oncol Biol Phys. 2004;60:1425–39.PubMedCrossRefGoogle Scholar
  60. 60.
    Feng FY, Kim HM, Lyden TH, et al. Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2007;68:1289–98.PubMedCrossRefGoogle Scholar
  61. 61.
    Jensen K, Lambertsen K, Grau C. Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters. Radiother Oncol. 2007;85:74–82.PubMedCrossRefGoogle Scholar
  62. 62.
    Caglar HB, Tishler RB, Othus M, et al. Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72:1110–8.PubMedCrossRefGoogle Scholar
  63. 63.
    Dirix P, Abbeel S, Vanstraelen B, et al. Dysphagia after chemoradiotherapy for head-and-neck squamous cell carcinoma: dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2009;75:385–92.PubMedCrossRefGoogle Scholar
  64. 64.
    Caudell JJ, Schaner PE, Desmond RA, et al. Dosimetric factors associated with long-term dysphagia after definitive radiotherapy for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 2010;76:403–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Bjordal K, Hammerlid E, Ahlner-Elmqvist M, et al. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J Clin Oncol. 1999;17:1008–19.PubMedGoogle Scholar
  66. 66.
    Hall EJ, Wuu CS. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys. 2003;56:83–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Castadot P, Lee JA, Geets X, et al. Adaptive radiotherapy of head and neck cancer. Semin Radiat Oncol. 2010;20:84–93.PubMedCrossRefGoogle Scholar
  68. 68.
    Beltran C. Image quality of an investigational imaging panel for use with the imaging beam line cone-beam CT. J Appl Clin Med Phys. 2012;13:3607.PubMedGoogle Scholar
  69. 69.
    Hansen EK, Bucci MK, Quivey JM, et al. Repeat CT imaging and replanning during the course of IMRT for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2006;64:355–62.PubMedCrossRefGoogle Scholar
  70. 70.
    Pignon JP, le Maitre A, Bourhis J, et al. Meta-Analyses of Chemotherapy in Head and Neck Cancer (MACH-NC): an update. Int J Radiat Oncol Biol Phys. 2007;69:S112–4.PubMedCrossRefGoogle Scholar
  71. 71.
    Adelstein DJ, Li Y, Adams GL, et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003;21:92–8.PubMedCrossRefGoogle Scholar
  72. 72.
    Kish J, Drelichman A, Jacobs J, et al. Clinical trial of cisplatin and 5-FU infusion as initial treatment for advanced squamous cell carcinoma of the head and neck. Cancer Treat Rep. 1982;66:471–4.PubMedGoogle Scholar
  73. 73.
    Ensley JF, Jacobs JR, Weaver A, et al. The correlation between response to cisplatinum-combination chemotherapy and subsequent radiotherapy in previously untreated patients with advanced squamous cell cancers of the head and neck. Cancer. 1984;54:811–4.PubMedCrossRefGoogle Scholar
  74. 74.
    The Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324:1685–90.CrossRefGoogle Scholar
  75. 75.
    Posner MR, Hershock DM, Blajman CR, et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med. 2007;357:1705–15.PubMedCrossRefGoogle Scholar
  76. 76.
    Pignon JP, le Maitre A, Maillard E, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 2009;92:4–14.PubMedCrossRefGoogle Scholar
  77. 77.
    Cohen E, Karrison T, Kocherginsky M, et al. DeCIDE: a phase III randomized trial of docetaxel (D), cisplatin (P), 5-fluoruracil (F) (TPF) induction chemotherapy (IT) in patients with N2/N3 locally advanced HNSCC. In: 2012 ASCO annual meeting 2012; abstract 550.Google Scholar
  78. 78.
    Haddad R, O’Neill A, Rabinowits G, et al. Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol. 2013;14:257–64.PubMedCrossRefGoogle Scholar
  79. 79.
    Leonard JH, Kearsley JH, Chenevix-Trench G, et al. Analysis of gene amplification in head-and-neck squamous-cell carcinoma. Int J Cancer. 1991;48:511–5.PubMedCrossRefGoogle Scholar
  80. 80.
    Morgillo F, Bareschino MA, Bianco R, et al. Primary and acquired resistance to anti-EGFR targeted drugs in cancer therapy. Differentiation. 2007;75:788–99.PubMedCrossRefGoogle Scholar
  81. 81.
    Lefebvre JL, Pointreau Y, Rolland F, et al. Induction chemotherapy followed by either chemoradiotherapy or bioradiotherapy for larynx preservation: the TREMPLIN randomized phase II study. J Clin Oncol. 2013;31:853–9.PubMedCrossRefGoogle Scholar
  82. 82.
    Morris LG, Sikora AG, Patel SG, et al. Second primary cancers after an index head and neck cancer: subsite-specific trends in the era of human papillomavirus-associated oropharyngeal cancer. J Clin Oncol. 2011;29:739–46.PubMedCentralPubMedCrossRefGoogle Scholar
  83. 83.
    Ha PK, Califano JA. The molecular biology of mucosal field cancerization of the head and neck. Crit Rev Oral Biol Med. 2003;14:363–9.PubMedCrossRefGoogle Scholar
  84. 84.
    Slaughter DP, Southwick HW, Smejkal W. Field cancerization in oral stratified squamous epithelium: clinical implications of multicentric origin. Cancer. 1953;6:963–8.PubMedCrossRefGoogle Scholar
  85. 85.
    Morris LG, Sikora AG, Patel SG, et al. Second primary cancers after an index head and neck cancer: subsite-specific trends in the era of human papillomavirus-associated oropharyngeal cancer. J Clin Oncol. 2011;29:739–46.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Carole Fakhry, Gypsyamber D’Souza, Rehan Kazi and Raghav C. Dwivedi 2015

Authors and Affiliations

  • Anthony J. Cmelak
    • 1
    Email author
  • Eleni Rettig
    • 2
  • F. Christopher Holsinger
    • 3
  1. 1.Department of Radiation OncologyVanderbilt-Ingram Cancer CenterNashvilleUSA
  2. 2.Department of Otolaryngology – Head and Neck SurgeryThe Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of Otolaryngology – Head and Neck SurgeryStandford University Medical CenterStanfordUSA

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