Oncoguía de carcinomas escamosos de las vías aerodigestivas superiores 2023

Abstract

Cancer of the upper aerodigestive tract includes a heterogeneous group of neoplasms. About 90% are squamous cells and rank sixth in incidence worldwide. Smoking, alcohol intake, and human papillomavirus infection are the main risk factors. Given the suspected diagnosis, histopathological confirmation by biopsy is required. Tomography is the primary imaging method for TNM staging. Management requires a multidisciplinary team with close communication between the different members. In general, we can divide the treatment according to the stage at diagnosis into: early, locally advanced, and recurrent or metastatic disease. Surgery is the best curative treatment option in early disease with the use of adjuvant radiotherapy and chemoradiotherapy in highrisk patients. When organ preservation is the objective and in unresectable tumors (common in locally advanced stages of the disease), chemoradiotherapy is an option. Induction chemotherapy is controversial; however, in patients with high tumor volume or if the initiation times of radiotherapy treatment are prolonged (mainly in the larynx), it could be an alternative. The recurrence of the disease is frequent. Even though the presentation with metastatic disease is rarer, the treatment objective will be palliative. Immunotherapy has improved overall survival in the first and second lines of treatment of recurrent or metastatic disease. Chemotherapy in combination with cetuximab (either first or second line) continues to be useful in these patients. The treatment decision will depend on the expression of PDL1 and the clinicopathological characteristics of the case.