Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck: A Big and Intriguing Challenge Which May Be Resolved by Integrated Treatments Combining Locoregional and Systemic Therapies

Franco Ionna, Paolo Bossi, Agostino Guida, Andrea Alberti, Paolo Muto, Giovanni Salzano, Alessandro Ottaiano, Fabio Maglitto, Davide Leopardo, Marco De Felice, Francesco Longo, Salvatore Tafuto, Giuseppina Della Vittoria Scarpati, Francesco Perri, Franco Ionna, Paolo Bossi, Agostino Guida, Andrea Alberti, Paolo Muto, Giovanni Salzano, Alessandro Ottaiano, Fabio Maglitto, Davide Leopardo, Marco De Felice, Francesco Longo, Salvatore Tafuto, Giuseppina Della Vittoria Scarpati, Francesco Perri

Abstract

Squamous cell carcinoma of the head and neck (SCCHN) is a complex group of malignancies, posing several challenges to treating physicians. Most patients are diagnosed with a locally advanced disease and treated with strategies integrating surgery, chemotherapy, and radiotherapy. About 50% of these patients will experience a recurrence of disease. Recurrent/metastatic SCCHN have poor prognosis with a median survival of about 12 months despite treatments. In the last years, the strategy to manage recurrent/metastatic SCCHN has profoundly evolved. Salvage treatments (surgery or re-irradiation) are commonly employed in patients suffering from locoregional recurrences and their role has gained more and more importance in the last years. Re-irradiation, using some particularly fractionating schedules, has the dual task of reducing the tumor mass and eliciting an immune response against cancer (abscopal effect). In this review, we will analyze the main systemic and/or locoregional strategies aimed at facing the recurrent/metastatic disease, underlining the enormous importance of the multidisciplinary approach in these types of patients.

Keywords: abscopal effect; immunotherapy; multidisciplinary team management; recurrent/metastatic; squamous cell carcinoma of the head and neck.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A flow-chart illustrating the therapeutic options in recurrent/metastatic SCCHN.

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Source: PubMed

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