CLINICAL REVIEW David W. Eisele, MD, Section Editor FUTURE OF THE TNM CLASSIFICATION AND STAGING SYSTEM IN HEAD AND NECK CANCER Robert P. Takes, MD, PhD, 1 Alessandra Rinaldo, MD, FRCS (Eng, Ir) ad eundem, FRCS Glasg, 2 Carl E. Silver, MD, 3 Jay F. Piccirillo, MD, CPI, 4 Missak Haigentz, Jr, MD, 5 Carlos Sua ´rez, MD, 6,7 Vincent Vander Poorten, MD, PhD, 8 Robert Hermans, MD, PhD, 9 Juan Pablo Rodrigo, MD, PhD, 6,7 Kenneth O. Devaney, MD, JD, FCAP, 10 Alfio Ferlito, MD, DLO, DPath, FRCSEd ad hominem, FRCS (Eng, Glasg, Ir) ad eundem, FDSRCS ad eundem, FHKCORL, FRCPath, FASCP, IFCAP 2 1 Department of Otolaryngology–Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. E-mail: r.takes@kno.umcn.nl 2 Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy 3 Departments of Surgery and Otolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 4 Department of Otolaryngology, Internal Medicine, and Occupational Therapy, Washington University School of Medicine, St Louis, MO 5 Department of Medicine, Division of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 6 Instituto Universitario de Oncologı ´a del Principado de Asturias, Oviedo, Spain 7 Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain 8 Department of Otolaryngology–Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium 9 Department of Radiology, University Hospitals Leuven, Leuven, Belgium 10 Department of Pathology, Allegiance Health, Jackson, MI Accepted 25 November 2009 Published online 26 February 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/hed.21361 Abstract: Staging systems for cancer, including the most uni- versally 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 treat- ment modalities tumor/biologic characteristics next to anatomic in- formation 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 environ- ment-related factors. Further improvement of the TNM classification is expected to result in better treatment choices, outcome and prog- nostication of patients with head and neck cancer. V V C 2010 Wiley Periodicals, Inc. Head Neck 32: 1693–1711, 2010 Keywords: TNM; classification; staging; head and neck cancer; prognostic factors Correspondence to: Robert P. Takes This paper was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com). V C 2010 Wiley Periodicals, Inc. Future of the TNM in Head and Neck Cancer HEAD & NECK—DOI 10.1002/hed December 2010 1693