Standards, Options and Recommendations (SOR) for clinical care of squamouscell carcinoma of the oropharynx

Context: The "Standards, Options and Recommendations" (SOR) project, starte d in 1993, is a collaboration between the Federation of the French Cancer C entres (FNCLCC), the 20, French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main object ive is the development of clinical practice guidelines to improve the quali ty of health care and outcome for cancer patients. The methodology is based on literature systematic review and critical appraisal by a multidisciplin ary group of experts, with feedback from specialists in cancer care deliver y. Objectives: To develop clinical practice guidelines according to the def initions of Standards, Options and Recommendations for the management of sq uamous carcinoma of the oropharynx. Methods: Data have been identified by l iterature search using Medline (1991-1998) and the expert groups personal r eference lists. Once the guidelines were defined, the document was submitte d for review to national and international independent reviewers and to the medical committees of the 20 French Cancer Centres. Results: The main reco mmendations for squamous cell carcinoma of the oropharynx management are th at: 1) diagnosis and initial assessment should be based on appropriate clin ical and radiological findings; 2) the therapeutic strategy is based on sur gery, radiotherapy, bradytherapy and chemotherapy; 3) in limited tumours, t he recommended strategy involved the use of one of these modality; 4) a mul timodality approach is recommended for the treatment of extended resecable tumours. Following results of recent meta-analyses, use of neo-adjuvant che motherapy is not recommended The same studies have shown that association o f chemotherapy and radiotherapy either in sequence or in combination signif icantly improve survival of extended curable tumours. These associations ar e recommended within the framework of clinical trials; 5) follow-up of squa mous carcinoma of the oropharynx should involve physical examination of the upper aerodigestive tract and the lymph nodes areas every three months dur ing the first year, every six months during the second year and then every year An annual chest x-ray is recommended. Other investigations should be p erformed as indicated by symptoms and clinical manifestations.