A systematic review of neoadjuvant and definitive immunotherapy in locally advanced head and neck squamous cell carcinoma

Neoadjuvant therapy with chemotherapy and immune checkpoint inhibitor for laryngeal function preservation in locally advanced hypopharyngeal cancer

Purpose

To evaluate the efficacy and laryngeal function preservation of neoadjuvant treatment with chemotherapy and immune checkpoint inhibitor for locally advanced hypopharyngeal cancer (LAHPC).

Methods

We retrospectively collected LAHPC patients who were diagnosed between February 2022 and June 2023. The patients received a combination of chemotherapy and immune checkpoint inhibitors as the neoadjuvant therapy. The response to treatment, laryngeal function preservation rate, and short-term survival were assessed.

Results

A total of 20 patients were included. Of these patients, 17 (85.0%) had stage IVA-B disease. Ten (50%) and four (20%) patients achieved pathological complete response (PCR) and major pathological response (MPR) to the primary tumor, respectively. In addition, 6 patients had incomplete pathological response (IPR). In the neck, 19 patients had node-positive disease before treatment, and only 5 patients (26.4%) had PCR to regional lymph nodes. Pathologically positive lymph nodes were still observed in 14 (73.6%) patients. Significant downgrading on narrow-band imaging assessment in primary tumors was associated with a higher probability of PCR or MPR than those with IPR (92.9% vs. 33.3%, P=0.014). The overall rate of laryngeal preservation was 95.0%. No severe perioperative complications or perioperative death were found. All patients completed the recommended postoperative radiotherapy/chemoradiotherapy. The median follow-up period was 12.1 months. The 1-year progression-free survival and overall survival were 94.1% and 92.9%, respectively. During the follow-up period, all 19 patients who underwent laryngeal preservation surgery had their laryngeal function preserved.

Conclusion

The addition of an immune checkpoint inhibitor to neoadjuvant chemotherapy effectively preserves laryngeal function without increasing complications related to surgery and postoperative radiotherapy in LAHPC.

Evaluation of neck control strategies for oral squamous cell carcinoma of stage I: Neck dissection or potential immunotherapy

The neck control strategies of early-stage oral squamous cell carcinoma (OSCC) patients with clinical node-negative neck remain uncertain. These patients could be benefit from elective neck dissection (END) alongside primary tumor excision; but current evidence on END versus observation for OSCC of stage I only is not yet analyzed collectively in detail. Herein, this short communication aimed to evaluate the neck control strategies of stage I OSCC, mainly END versus observation. A total of 740 patients with stage I OSCC, comprising 434 underwent END and 306 received observation, were identified from literature. The results showed that stage I OSCC patients would not be benefit from END based on the analysis of neck nodal recurrence and overall survival. An ideal strategy would likely be to avoid neck dissection for stage I OSCC patients with N0 neck. Immune checkpoint therapy is such a potential strategy, which aims at eliciting potent antitumor immune responses within lymph nodes hold promise for treating patients with early-stage OSCC and may prove more efficacious than lymphadenectomy in a variety of scenarios. Consequently, neck dissection for stage I OSCC could be approached with caution, particularly in patients receiving immune checkpoint therapy.

The Use of Contrast-Enhanced Sonography for Therapy Monitoring of Metastatic Lymph Nodes: A Systematic Review

Metastatic cervical lymph nodes are a frequent finding in head and neck squamous cell carcinoma (HNSCC). If a non-surgical approach is primarily chosen, a therapy response evaluation of the primary tumor and the affected lymph nodes is necessary in the follow-up. Supplementary contrast-enhanced ultrasound (CEUS) can be used to precisely visualize the microcirculation of the target lesion in the neck, whereby malignant and benign findings differ in their uptake behavior. The same applies to many other solid tumors. For various tumor entities, it has already been shown that therapy monitoring is possible through regular contrast-enhanced sonography of the primary tumor or the affected lymph nodes. Thus, in some cases, maybe in the future, a change in therapy strategy can be achieved at an early stage in the case of non-response or, in the case of therapy success, a de-escalation of subsequent (surgical) measures can be achieved. In this paper, a systematic review of the available studies and a discussion of the potential of therapy monitoring by means of CEUS in HNSCC are presented.