Loco-regional recurrence within 6 months of definitive chemoradiation, new distant metast...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-HNSCC-TRANSFORMATION-PROGRESSION`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-HNSCC`
Sources	`SRC-NCCN-NSCLC-2025` `SRC-ONCOKB`

Red Flag Origin

Definition	Loco-regional recurrence within 6 months of definitive chemoradiation, new distant metastasis (lung, bone, liver), carotid blowout risk on imaging, or rapid airway compromise — emergency-tier flag requiring airway / vascular evaluation, salvage-surgery feasibility review, and immediate transition from curative to palliative-systemic intent.
Clinical direction	hold
Category	transformation-progression

Trigger Logic

{
  "any_of": [
    {
      "all_of": [
        {
          "finding": "locoregional_recurrence",
          "value": true
        },
        {
          "comparator": "<=",
          "finding": "months_since_definitive_therapy",
          "threshold": 6
        }
      ]
    },
    {
      "finding": "new_distant_metastasis",
      "value": true
    },
    {
      "finding": "carotid_encasement_imaging",
      "value": true
    },
    {
      "finding": "airway_compromise",
      "value": true
    }
  ],
  "type": "composite_clinical"
}

Notes

Early loco-regional recurrence (<6 mo) after CRT carries dismal prognosis (mOS ~6–9 mo) and excludes most curative re-irradiation trials (RTOG 0421 / 1009 require ≥6 mo). Salvage surgery feasibility is the key axis — multidisciplinary review mandatory. Carotid encasement on imaging is a surgical contraindication and predicts fatal blowout if re-irradiated; embolization / palliation only. Airway compromise: tracheostomy before any chemo / RT escalation. Transition to KEYNOTE-048-style palliative systemic therapy (pembrolizumab ± chemo by CPS) when re-treatment infeasible.

Used By

Algorithms

ALGO-HNSCC-RM-1L - ALGO-HNSCC-RM-1L