30-Second Takeaway
- ctDNA-guided, risk-adaptive therapy in nasopharyngeal carcinoma substantially improves 3-year failure-free survival vs a contemporaneous external cohort.
- For early HPV-positive oropharyngeal cancer, transoral surgery and definitive RT/CRT yield similar survival, with different but non-randomized functional trade-offs.
- Fluorescence-guided fresh frozen sectioning can markedly increase clear-margin rates in oral cavity SCC without prolonging operative time.
- Submandibular gland preservation during neck dissection appears oncologically safe in early-stage OSCC, given very low true gland involvement rates.
- Quality of life in unilateral vestibular schwannoma is broadly similar across observation, radiosurgery, and microsurgery on PANQOL metrics.
Week ending March 14, 2026
Targeted updates in head and neck oncology, laryngology, and skull base care
ctDNA-guided, risk-adaptive therapy improves 3-year outcomes in nasopharyngeal carcinoma
In the multi-center phase II EP-STAR study, nasopharyngeal carcinoma patients started with standard gemcitabine–cisplatin neoadjuvant chemotherapy. Subsequent chemoradiation was adapted according to on-treatment ctDNA clearance, versus a contemporaneous ctDNA cohort managed without risk-adaptive treatment. Three-year failure-free survival in the ctDNA-guided group was 89.1% after 47.3 months’ median follow-up. Risk-adapted therapy significantly improved failure-free survival compared with the external no-RAT cohort (hazard ratio 0.41; p = 0.004). The ctDNA-driven strategy was well tolerated, with no treatment-related deaths reported.
Transoral surgery vs definitive RT/CRT in early HPV-positive OPSCC: similar survival, different morbidities
This systematic review and meta-analysis compared transoral surgery plus risk-adapted adjuvant therapy with definitive RT/CRT in early HPV-positive oropharyngeal SCC. Across seven studies, there were no statistically significant differences in overall or disease-free survival between strategies. Roughly one-third of surgical patients received adjuvant radiotherapy and another third adjuvant chemoradiotherapy, limiting de-escalation potential. Surgery-based management showed numerically lower 1-year gastrostomy dependence and toxicity but more bleeding and tracheostomy, based on descriptive data. Small samples, wide confidence intervals, and predominantly observational designs restrict firm conclusions on survival and function.
Fluorescence-guided frozen sectioning boosts clear-margin rates in oral cavity SCC
This phase II trial tested cetuximab-IRDye800CW fluorescence-guided fresh frozen sectioning for intraoperative margin assessment in oral squamous cell carcinoma. After initial resection, 10 of 20 patients had inadequate margins; fluorescence-guided frozen sectioning correctly classified margin status in 19 of 20 cases. Additional resections increased tumour-free margins over 5 mm from 50% to 85%, with one case limited by anatomy. Intraoperative margin adjustment reduced the need for adjuvant treatment in seven patients without delaying surgery.
Submandibular gland preservation during neck dissection appears safe in early OSCC
This systematic review and meta-analysis evaluated submandibular gland involvement and outcomes with or without gland preservation during neck dissection for oral SCC. Among 7,492 patients, pooled submandibular gland involvement was 1.55%, mainly from direct primary extension or extranodal spread; intraglandular metastasis was rare. Most involved glands occurred in T3–T4 or node-positive disease, with very few cases in T1–T2, N0 patients. Across five comparative studies, recurrence rates did not differ significantly between preservation and excision groups (risk ratio 1.11; 95% CI 0.69–1.79). These data support considering submandibular gland preservation in carefully selected early-stage T1–T2, N0 cases, acknowledging low evidence certainty.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.