Current role of primary surgical treatment in patients with head and neck squamous cell carcinoma

Abstract

Purpose of review The objective of this review article is to discuss the current role of surgery as the primary treatment modality in patients with head and neck squamous cell carcinoma (HNSCC). Recent findings HNSCC represents one of the cancer locations where the primary treatment modality is the most under discussion. Indeed, the respective roles of primary surgical resection followed, as necessary, by adjuvant radiotherapy or definitive chemoradiotherapy remain controversial. The results of organ preservation trials and the drastic rise in the incidence of human papillomavirus-induced oropharyngeal tumors, which are known to be highly radiosensitive, have led to an increasing use of chemoradiation-based therapies in HNSCC patients. However, no chemoradiation-based protocol has shown better oncologic outcomes than radical primary surgery. Moreover, development of minimally invasive surgical techniques, such as transoral robotic surgery, and advances in head and neck microvascular reconstruction have considerably improved the clinical outcomes of the patients and have led to a reconsideration of the role of primary surgery in HNSCC patients. Summary Surgery should be the primary treatment modality for most resectable oral cavity cancers and for T4a laryngeal/hypopharyngeal cancers. Primary surgery could also be the preferred modality of treatment for most early (T1–T2, N0) laryngeal and hypo/oropharyngeal carcinomas when this strategy offers an opportunity to reserve radiotherapy for a potential recurrence or second primary tumor. Primary surgery should also be considered in patients with locally advanced human papillomavirus-negative oropharyngeal carcinoma.

Hyperspectral Imaging of Head and Neck Squamous Cell Carcinoma for Cancer Margin Detection in Surgical Specimens from 102 Patients Using Deep Learning

“…Surgery is often the primary treatment for head and neck squamous cell carcinoma (HNSCC) [1]. Primary surgery is the modality of choice for resectable oral cavity cancers and late stage disease of the larynx and hypopharynx [2]. Management of locally advanced SCC may also require a multimodal approach with adjuvant chemoradiation therapy [1,3].…”

“…Nearly 90% of cancers of the upper aerodigestive track of the head and neck are SCC [4,5]. Depending on the extent of the disease, radiation therapy or chemotherapy alone may be the primary curative modality selected, such can be the case with unresectable, recurrent, or metastatic cancers and also with cases known to be susceptible to chemoradiation [1,2]. Human papilloma virus (HPV) is an identified cause of SCC, and the most common location for HPV positive (HPV+) SCC is the oropharynx, with nearly 60% of oropharyngeal SCC cases being HPV+ [1,6].…”

Discovery and Validation of a CT-Based Radiomic Signature for Preoperative Prediction of Early Recurrence in Hypopharyngeal Carcinoma

“…In the Western countries, clinicians tend to choose less expensive conservative treatment (radiotherapy and chemotherapy) due to its low incidence [ 1 ], while in China, HSCC patients typically receive comprehensive treatment with surgery [ 2 ]. A variety of surgical skills and principles have been developed, resulting in significant improvement for laryngeal function and swallowing function [ 3 , 4 ].…”

Imaging angiogenesis in patients with head and neck squamous cell carcinomas by [68Ga]Ga-DOTA-E-[c(RGDfK)]2 PET/CT

“…Head and neck squamous cell carcinomas of the mucosal surfaces (HNSCC) are the most common type of all head and neck cancers, with approximately 890,000 new cases in 2018 worldwide [1]. Current treatment options for HNSCC depend on the primary site of the cancer, stage, resectability, and wish to preserve functional outcome [2,3]. In oral squamous cell carcinomas (OSCC), surgery with on indication followed by (chemo)radiotherapy is the first choice of treatment, whereas in most other sites in the head and neck region, (chemo)radiation is the first choice.…”