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Future of the TNM classification and staging system in head and neck cancer

Authors

  • Robert P. Takes MD, PhD,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
    • Department of Otolaryngology–Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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  • Alessandra Rinaldo MD, FRCS (Eng, Ir) ad eundem, FRCS Glasg,

    1. Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
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  • Carl E. Silver MD,

    1. Departments of Surgery and Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
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  • Jay F. Piccirillo MD, CPI,

    1. Department of Otolaryngology, Internal Medicine, and Occupational Therapy, Washington University School of Medicine, St Louis, MO
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  • Missak Haigentz Jr MD,

    1. Department of Medicine, Division of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
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  • Carlos Suárez MD,

    1. Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
    2. Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
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  • Vincent Van der Poorten MD, PhD,

    1. Department of Otolaryngology – Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
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  • Robert Hermans MD, PhD,

    1. Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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  • Juan Pablo Rodrigo MD, PhD,

    1. Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
    2. Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
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  • Kenneth O. Devaney MD, JD, FCAP,

    1. Department of Pathology, Allegiance Health, Jackson, MI
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  • Alfio Ferlito MD, DLO, DPath, FRCSEd ad hominem, FRCS (Eng, Glasg, Ir) ad eundem, FDSRCS ad eundem, FHKCORL, FRCPath, FASCP, IFCAP

    1. Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
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  • This paper was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).

Abstract

Staging systems for cancer, including the most universally used TNM classification system, have been based almost exclusively on anatomic information. However, the question arises whether staging systems should be based on this information alone. Other parameters have been identified that should be considered for inclusion in classification systems like the TNM. This is all the more important, as a shift toward nonsurgical treatments for head and neck cancer has been made over the years. For these treatment modalities tumor/biologic characteristics next to anatomic information may be particularly important for treatment choice and outcome. The shortcomings of the current TNM classification system will be discussed, along with suggestions for improvement and expansion of the TNM system based on tumor, patient, and environment-related factors. Further improvement of the TNM classification is expected to result in better treatment choices, outcome and prognostication of patients with head and neck cancer. © 2010 Wiley Periodicals, Inc. Head Neck, 2010

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