Response-adapted surgical de-escalation following neoadjuvant immunotherapy in resectable mucosal HNSCC A systematic review and meta-analysis.
Liyona Kampel, Yahav Bordovski, Anton Warshavsky et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the safety and efficacy of response-adapted surgery (RAS) following neoadjuvant immunotherapy in 202 patients with resectable mucosal head and neck squamous cell carcinoma (HNSCC). The study found that RAS achieved a pooled overall event-free survival of 83.3% and overall survival of 92.3%, comparable to baseline-planned surgery outcomes, while significantly increasing the pathologic complete response rate to 41.7%.
Key findings
- Pooled overall event-free survival for RAS was 83.3% compared to 82% for baseline-planned surgery (P=.751).
- Pooled overall survival for RAS was 92.3% versus 91.4% for baseline-planned surgery (P=.839).
- The pathologic complete response rate was significantly higher for RAS at 41.7% compared to 19.8% for baseline-planned surgery (P=.001).
- RAS was associated with greater organ preservation and reduced need for mandibulectomy and free-flap reconstruction.
Why it matters
The findings suggest that response-adapted surgery following neoadjuvant immunotherapy may provide similar oncologic outcomes to traditional surgical approaches while enhancing functional preservation, which is crucial for patient quality of life.