Surgery, radiotherapy and chemotherapy are the main treatments for squamous carcinoma of the head and neck, but to some extent they can also cause damage to head and neck organs and functions, and lead to a decrease in patients’ quality of life.
In order to achieve the goal of maximizing the preservation of physiological characteristics and quality of life while achieving tumor control, a comprehensive assessment including the patient’s general condition, tumor site, TNM stage and pathological type is required before treatment, while weighing the pros and cons of all treatment modalities.
Treatment of early and locally advanced squamous carcinoma of the head and neck
If the functional and cosmetic impact of surgery is low, surgery is the recommended treatment of choice; otherwise, radiation therapy should be recommended as the first choice.
Locally advanced laryngeal cancer, oropharyngeal cancer and hypopharyngeal cancer that can be surgically removed.
1.Surgery + radiotherapy (patients with laryngeal cancer and those who can preserve or reconstruct laryngeal function after resection of primary focus are suitable for this treatment).
2.Simultaneous radiotherapy (cisplatin) + salvage surgery (if there is residual).
3.Induction chemotherapy + radiotherapy or simultaneous radiotherapy + surgery.
Locally advanced unresectable tumors: synchronous radiotherapy, or induction chemotherapy + radiotherapy combined or not combined with synchronous chemotherapy.
Cetuximab + radiotherapy remains the best alternative treatment option for patients who are not suitable for these treatments.
Treatment of recurrent and/or metastatic squamous head and neck cancer
First-line treatment recommendations: platinum/5-FU in combination with cetuximab; platinum/paclitaxel in combination with cetuximab (in patients who cannot tolerate 5-FU); paclitaxel in combination with cetuximab (in patients who cannot tolerate platinum); platinum in combination with 5-FU/paclitaxel; or single agent platinum, paclitaxel, methotrexate, and cetuximab alone (in patients who cannot tolerate combination therapy).
Second-line/treatment recommendations: paclitaxel in combination with cetuximab (in patients who have not used paclitaxel); cetuximab monotherapy (in patients who have not used cetuximab); other chemotherapy monotherapy not used in first-line therapy.
Recommended treatment for patients with poor functional status (PS score >2): best supportive care.
Treatment of nasopharyngeal carcinoma
For early-stage patients: Radical radiotherapy alone combined/not combined with platinum-based concurrent radiotherapy is reasonable, but prospective clinical studies are recommended to clarify the role of chemotherapy.
For locally advanced lesions: radiotherapy combined/not combined with simultaneous platinum-based adjuvant chemotherapy. In eligible patients, cetuximab may be added to the standard radiotherapy regimen.
The importance of multidisciplinary collaborative treatment
Multidisciplinary collaborative care helps to optimize tumor staging, evaluate treatment plans, preserve patient function, improve quality of life, and provide the most effective individualized treatment for patients.
Multidisciplinary collaboration should include specialists from multiple disciplines to integrate medical resources.