Abstract:

Approximately two-thirds of patients with head and neck squamous cell carcinoma present with locally advanced disease at the time of consultation. Even with the multidisciplinary team (MDT) diagnosis and treatment model, their treatment outcomes still need improvement. Immunotherapy has become the standard treatment for recurrent and metastatic head and neck squamous cell carcinoma. In recent years, it has achieved initial success in clinical studies on locally advanced diseases, especially in the perioperative period, but its application in other treatment fields still faces many problems. The Head and Neck Cancer Committee of Chinese Society of Clinical Oncology organized experts to form 14 consensus opinions through multiple rounds of discussions informed by evidence-based medical evidence and clinical practice. Thess consensus statements were finally formulated, comprehensively covering the entire management of immunotherapy for locally advanced head and neck squamous cell carcinoma, summarized as follows: ① Regarding the whole-course treatment strategy, for patients with locally advanced head and neck squamous cell carcinoma undergoing radical surgery followed by adjuvant chemoradiotherapy, a comprehensive treatment approach combining neoadjuvant immunotherapy, immunotherapy combined with chemoradiotherapy, and adjuvant immunotherapy is recommended. ② In the neoadjuvant treatment phase, for patients requiring neoadjuvant immunotherapy, the combination of immunotherapy with chemotherapy is recommended, with a course of 2-3 cycles. For non-oral cancer patients who achieve radiological tumor response after neoadjuvant treatment and require organ preservation, definitive radiotherapy should be administered. ③ The immunotherapy combined with radiotherapy phase remains controversial, and the optimal treatment regimen and patient selection criteria require further clinical investigation. ④ In the adjuvant immunotherapy phase, for locally advanced head and neck squamous cell carcinoma patients with high-risk factors, the combination of adjuvant radiotherapy with immunotherapy is recommended postoperatively, with a course of adjuvant immunotherapy ranging from 6 to 12 months. Corresponding recommendation levels for different treatment scenarios are obtained through voting. This consensus will help guide the standardized application of immunotherapy for locally advanced head and neck squamous cell carcinoma, lay the foundation for further clinical research, and strive to promote the research level of immunotherapy for locally advanced head and neck squamous cell carcinoma in China.This consensus has been registered on the Practice guideline REgistration for transPAREncy (PREPARE) platform, with the registration number PREPARE-2025CN1241.

Key words: Locally advanced head and neck squamous cell carcinoma, Multidisciplinary treatment, Immunotherapy, Immune checkpoint inhibitor, Expert consensus