Recurrent Versus Metastatic Head and Neck Cancer: An Evolving Landscape and the Role of Immunotherapy

Abstract

Squamous cell carcinoma of the head and neck (SCCHN) is among the ten most common cancers worldwide, with advanced SCCHN presenting with a 5-year survival of 34% in the case of nodal involvement and 8% in the case of metastatic disease. Disease-free survival at 2 years is 67% for stage II and 33% for stage III tumors, whereas 12-30% of patients undergo distant failures after curative treatment. Previous treatments often hinder the success of salvage surgery and/or reirradiation, while the standard of care for the majority of metastatic SCCHN remains palliative chemo- and immuno-therapy, with few patients eligible for locoregional treatments. The aim of this paper is to review the characteristics of recurrent SCCHN, based on different recurrence sites, and metastatic disease; we will also explore the possibilities not only of salvage surgery and reirradiation but also systemic therapy choices and locoregional treatment for metastatic SCCHN.

Keywords: head and neck; locoregional disease; locoregional treatment; reirradiation; salvage surgery.

Figure 1

Recurrence in the anterior third of the hemitongue in a patient treated by surgery in the lower margin of the hemitongue. (A) The image shows a T2-weighed image, (B) shows a restriction signal in the diffusion-weighed image, (C) shows increased enhancement after intravenous injection of the contrast medium.

Figure 2

Example of a recurrence in the laterocervical right side with involvement of the thorax inlet in a patient with a larynx carcinoma treated with total laryngectomy with laterocervical dissection. (A) T2-weighted image. (B) Contrast enhancement shows that recurrence tissue is not dissociated from brachiocephalic vessels and sternocleidomastoideo muscle.