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One of the main goals of neoadjuvant (induction) therapy before surgery ± adjuvant treatment in head and neck cancer is to downsize the disease and to reduce the need for further aggressive adjuvant treatment. A classic example for this strategy has been shown for larynx preservation treatment by using cisplatin/5-fluorouracil (PF) induction chemotherapy in advanced laryngeal and hypopharyngeal cancer. Currently, the benefit for the individual patient with an indication for total laryngectomy would only be given if the tumor responds well to induction therapy and the larynx can be preserved in its entirety through subsequent radiation. Chances for that have increased since taxanes (T) have been added to the traditional PF regimen (TPF). In the event of residual tumor, however, a total laryngectomy would still have to be carried out. The advantage for the patient only arises if he or she becomes completely tumor-free through non-surgical therapy. Any kind of down staging with reduced surgical extent is currently not accepted, meaning that any salvage surgery must be performed using the original margins to end up safely with a R0-resection. However, most randomized trials and meta-analyses in patients with locoregionally advanced squamous cell carcinoma of the head and neck indicated that induction chemotherapy before local treatment, whether surgery or (chemo)radiation, could not improve overall survival. Therefore, induction chemotherapy has lost its influence in standard treatment beyond that in larynx preservation procedures. In more recent years, induction chemotherapy as part of perioperative transoral surgical treatment concepts in oropharyngeal carcinoma is gaining interest again. In addition to conventional chemotherapy, the use of upfront immune checkpoint-inhibitors alone or in combination has shown to be effective in uncontrolled trials, thereby opening a new door of encouraging treatment options. The following chapter summarizes and discusses the current development of clinical trials and first results of neoadjuvant strategies for modification of subsequent surgery.

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Is Reducing the Extent of Local Treatments Justified After Successful Neoadjuvant Therapy?

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  • 出版模式：

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  • 发表日期：

    2025年

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  • Andreas Dietz,
  • Jan B. Vermorken

摘要

One of the main goals of neoadjuvant (induction) therapy before surgery ± adjuvant treatment in head and neck cancer is to downsize the disease and to reduce the need for further aggressive adjuvant treatment. A classic example for this strategy has been shown for larynx preservation treatment by using cisplatin/5-fluorouracil (PF) induction chemotherapy in advanced laryngeal and hypopharyngeal cancer. Currently, the benefit for the individual patient with an indication for total laryngectomy would only be given if the tumor responds well to induction therapy and the larynx can be preserved in its entirety through subsequent radiation. Chances for that have increased since taxanes (T) have been added to the traditional PF regimen (TPF). In the event of residual tumor, however, a total laryngectomy would still have to be carried out. The advantage for the patient only arises if he or she becomes completely tumor-free through non-surgical therapy. Any kind of down staging with reduced surgical extent is currently not accepted, meaning that any salvage surgery must be performed using the original margins to end up safely with a R0-resection. However, most randomized trials and meta-analyses in patients with locoregionally advanced squamous cell carcinoma of the head and neck indicated that induction chemotherapy before local treatment, whether surgery or (chemo)radiation, could not improve overall survival. Therefore, induction chemotherapy has lost its influence in standard treatment beyond that in larynx preservation procedures. In more recent years, induction chemotherapy as part of perioperative transoral surgical treatment concepts in oropharyngeal carcinoma is gaining interest again. In addition to conventional chemotherapy, the use of upfront immune checkpoint-inhibitors alone or in combination has shown to be effective in uncontrolled trials, thereby opening a new door of encouraging treatment options. The following chapter summarizes and discusses the current development of clinical trials and first results of neoadjuvant strategies for modification of subsequent surgery.