Oral Oncology Reports (Jun 2023)
Has upfront radiotherapy “come to age” as the standard of care in the management of head and neck squamous cell carcinomas
Abstract
Introduction: Surgery is considered the standard of care in operable head and neck squamous cell carcinomas (HNSCC), both in the early stage or locally advanced cancers, with post-operative radiotherapy (PORT) having a strong role based on the risk profile of the resected tumor. However, with the vast improvement in the definitive radiotherapy (dRT)/definitive chemoradiotherapy (dCRT) loco-regional control (LRC) rate in recent times, there is a need to re-look into this age-old concept. Methods: Electronic databases (PubMed and Google Scholar) were searched to identify all the relevant HNSCC studies that report on dRT, dCRT, PORT and studies that compared dRT/dCRT against upfront surgery. The data is presented in descriptive manner. Results: Initial search revealed a total of 423 studies which was narrowed down to 38 publications after going through the abstract, full manuscript and further search of the reference sections of the identified manuscripts. The reported range of LC/LRC rate with dRT/dCRT in the literature; HNSCC (all subsites): 69.2%–87% at 3–10 years, 78%–93.9% at 3–4 years with IMRT only; sinonasal SCC: 70%–94% at 2–10 years; oral cavity SCC(OCSCC): 30%–78% at 2–5 years, 80%–94% at 2–5 years (oral tongue with brachytherapy); hypopharyngeal SCC: 78% at 5 and 10 years; larynx T1-T2 85%–90% at 5-years, T3-T4 70%–84% at 3–3.8 years; oropharyngeal SCC: 98% at 2 years, 72% at 1 year (non-HPV). Conclusion: Surgery as single modality is probably of no benefit in terms of LC if PORT is not administered for the high-risk group of HNSCC patients. Current LRC rate with dRT/dCRT in has paralleled that of surgical series with PORT for all subsites except for OCSCC. Novel approach such as combining brachytherapy with IMRT for OCSCC may improve the LC rate. Future studies should compare the quality of life in patients undergoing surgery or dRT since the outcomes in terms of LR/LRC rate for both modality is equivocal. Without a conclusive benefit, patients should not be subjected to double toxicity of surgery and PORT.
