30-Second Takeaway
- Tislelizumab plus gemcitabine–cisplatin provides durable PFS and adjusted OS benefit in first-line recurrent/metastatic NPC with manageable toxicity.
- Metastatic lesion radiotherapy improves survival in de novo metastatic NPC, especially oligometastatic and bone-only disease, with benefit at higher biologically effective doses.
- For cT1–T2N0 oral cavity SCC, elective neck dissection guided by depth of invasion around 4 mm improves survival and regional control.
- MRI outperforms CT for detecting laryngeal cartilage and paraglottic space invasion, reducing T-stage understaging while maintaining similar specificity.
- High-volume centers, risk stratification for salvage, probiotics for pediatric OME, and long-term autoimmunity risk after T&A should inform referral and counseling.
Week ending February 28, 2026
Current shifts in head and neck oncology: immunotherapy in NPC, DOI-guided neck management, imaging for laryngeal staging, and systems-level determinants of outcomes
Tislelizumab plus gemcitabine–cisplatin as first-line standard for recurrent/metastatic nasopharyngeal carcinoma
In treatment-naive recurrent or metastatic NPC, adding tislelizumab to gemcitabine–cisplatin prolonged PFS versus chemotherapy alone (9.6 vs 7.4 months; HR 0.53). Overall survival also favored tislelizumab (45.3 vs 31.8 months; HR 0.73), with crossover-adjusted analyses suggesting greater benefit (HRs 0.56–0.62). Safety was comparable between arms, with similar rates of grade ≥3 adverse events, though immune-mediated events were more frequent with tislelizumab. These data support PD-1 inhibition plus platinum–gemcitabine as a first-line standard for recurrent/metastatic NPC in appropriate candidates.
Metastatic-site radiotherapy improves survival in de novo metastatic nasopharyngeal carcinoma
Among 1,503 patients with de novo metastatic NPC, metastatic lesion radiotherapy (MLRT) was associated with higher 3-year OS after matching (79.0% vs 65.8%). MLRT remained an independent favorable prognostic factor on multivariable analysis (HR 0.64 for death). Benefit was most evident in oligometastatic disease, bone metastases, ≤5 lesions, and patients with undetectable EBV DNA after 2–6 chemotherapy cycles. Higher MLRT doses (BED >72 Gy, EQD2 >60 Gy) correlated with improved OS, supporting definitive-dose approaches in selected patients.
Depth-of-invasion–guided elective neck dissection improves outcomes in early oral cavity SCC
This systematic review evaluated DOI-guided elective neck dissection (END) in cT1–T2N0 oral cavity SCC under AJCC-8 staging. END improved overall survival (HR 0.64) and disease-free survival (HR 0.45) compared with observation. DOI ≥5 mm independently increased nodal failure risk, and END improved neck control versus observation in registry data. ROC analyses showed diagnostic DOI thresholds clustering around 4 mm overall and approximately 3 mm for higher-risk subsites. The authors conclude DOI is the primary determinant for recommending END, integrated with histopathologic and subsite-specific risk factors.
References
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Additional Reads
Optional additional studies from this edition.