Malignant tumors of the head and neck refer to a group of cancers that originate in the nasal sinuses, pharynx (nasopharynx, oropharynx, hypopharynx), oral cavity, and larynx, among other areas. These cancers are most common in men over 50 years of age and represent the sixth most prevalent type of malignancy worldwide, with over 90% being squamous cell carcinomas. Malignant head and neck tumors account for approximately 10% of all malignancies.
Heavy smoking and alcohol consumption are common risk factors for oral cancer, oropharyngeal cancer, hypopharyngeal cancer, and laryngeal cancer. Roughly 50% of oropharyngeal cancers are associated with human papillomavirus (HPV) infections, while the incidence of nasopharyngeal carcinoma is closely linked to Epstein-Barr virus (EBV) infection. These tumors often arise in concealed anatomical locations and lack specific symptoms in the early stages. Consequently, the majority of patients are diagnosed at intermediate or advanced stages, frequently presenting with cervical lymph node metastases or local invasion of surrounding tissues or organs.
For patients with intermediate to advanced stages of malignant head and neck tumors, neither surgery nor radiotherapy alone provides satisfactory outcomes and may severely compromise vital functions such as speech, breathing, and swallowing. Current treatment approaches depend on factors such as tumor site, pathological type, degree of differentiation, clinical stage, and the patient's overall condition. Multidisciplinary and carefully planned treatment strategies are employed to significantly improve cure rates and enhance quality of life. Malignant head and neck tumors are generally highly sensitive to radiotherapy. A comprehensive treatment model combining surgery and radiotherapy, supplemented by chemotherapy or immunotherapy, has become the prevailing approach for most malignant head and neck tumors. This treatment strategy aims to address two key goals: prolonging survival and preserving organ function. For cancers with distinctive biological behaviors, such as thyroid cancer and nasopharyngeal carcinoma, tailored management approaches should be consulted in their respective sections.
Apart from nasopharyngeal carcinoma, large-scale prospective clinical studies on malignant head and neck tumors are scarce. Treatment recommendations and methods should align with clinical practice guidelines, expert consensus, and the resources and experience of the treating institution.
Early-Stage Lesions
Early-stage malignant head and neck tumors (Tis-T1N0, some T2N0) may be treated using surgery or radiotherapy alone, with comparable efficacy between the two modalities. Surgical procedures prioritize function-preserving techniques (e.g., minimally invasive surgery under microscopy or endoscopy), such as CO2 laser resection under suspension laryngoscopy for early-stage laryngeal cancer. Surgical options depend on multiple factors, including the clinician's expertise and available equipment, and should be based on strict indications. Radiotherapy can be tailored to the primary tumor site, tumor mobility, and institutional capabilities, with techniques such as intensity-modulated radiation therapy (IMRT) commonly used.
Intermediate- and Advanced-Stage Lesions
Combined treatment modalities involving surgery and radiotherapy represent the primary approach for intermediate- and advanced-stage malignant head and neck tumors. Radiotherapy, as part of a comprehensive treatment plan, can be administered preoperatively or postoperatively, depending on its timing relative to surgical intervention.
Preoperative Radiotherapy
This typically occurs 2–6 weeks before surgery, allowing time for recovery from systemic effects and acute radiation-induced inflammation.
Advantages
Tumor oxygenation is optimal, enhancing radiotherapy sensitivity; the risk of postoperative margin recurrence is reduced; the likelihood of intraoperative tumor cell dissemination is decreased; and opportunities for optimizing the patient’s nutritional status and cardiopulmonary function are available.
Disadvantages
Radiation-induced inflammation and tissue edema increase surgical complexity; wound healing may be compromised, raising the risk of complications such as pharyngocutaneous fistulas.
Postoperative Radiotherapy
This is generally performed 2–6 weeks after surgery, with the treatment plan based on factors such as the tumor’s primary site, pathology, and stage.
Advantages
Surgical timing and difficulty are not affected; occult subclinical lesions can be effectively eradicated, improving local control rates; a comprehensive assessment of the primary tumor and metastatic lymph nodes can be performed.
Disadvantages
Complications such as pharyngocutaneous fistulas and wound infections may occur; tissue hypoxia in the surgical area reduces radiotherapy sensitivity; postoperative complications and the patient’s overall condition may delay the radiotherapy schedule, missing the optimal treatment window.
Other Treatment Modalities
In addition to the aforementioned approaches, several other treatment methods are commonly employed for intermediate- and advanced-stage malignant tumors of the head and neck:
Induction Chemotherapy
Also referred to as neoadjuvant chemotherapy, this approach involves administering chemotherapy prior to radiotherapy. Since the tumor's blood supply and local anatomy remain unchanged before radiotherapy, chemotherapy drugs can penetrate the tumor tissue more effectively. This method can rapidly reduce tumor burden, downgrade the tumor stage, enhance the tumor's sensitivity to radiotherapy, and eliminate subclinical metastatic lesions.
Adjuvant Chemotherapy
Adjuvant chemotherapy is administered after surgery or radiotherapy to eradicate potentially residual micrometastases. The goal is to reduce the risk of recurrence and metastasis, thereby improving cure rates through the use of chemotherapeutic agents.
Targeted Therapy
More than 90% of head and neck squamous cell carcinomas (HNSCC) overexpress the epidermal growth factor receptor (EGFR), which is associated with tumor proliferation, invasion, angiogenesis induction, and apoptosis inhibition. Targeting EGFR is an effective therapeutic strategy for malignant head and neck tumors and is frequently combined with radiotherapy or chemotherapy. Targeted therapy plays an important role in the comprehensive treatment of locally advanced head and neck cancers. Currently, the primary EGFR-targeting agents used in clinical practice include cetuximab and nimotuzumab.
Immunotherapy
Immunotherapy represents a key area of interest and emerging trend in cancer treatment. In head and neck malignancies, immune checkpoint inhibitors have shown the most significant efficacy. Among these, programmed cell death-1 (PD-1) inhibitors have been approved for second-line treatment of recurrent or metastatic head and neck cancers. Further research in this area holds promising potential.