Head and neck cancer is the seventh most common cancer globally. With improvements in treatment, survival rates have increased, making it a chronic condition for many. However, patients frequently experience substantial changes in physical appearance, speech, swallowing, and other functions, leading to diminished quality of life and significant psychological distress. In recent years, self-management has been identified as a potential intervention to support cancer survivors in managing symptoms, regaining function, and improving psychosocial well-being. While its benefits are recognized in other cancer populations, evidence specific to head and neck cancer remains insufficient. This study conducted a systematic review of randomized controlled trials (RCTs) that evaluated the effects of self-management interventions on quality of life in patients with head and neck cancer. A comprehensive search was performed in four databases: PubMed, Web of Science, Embase, and Airiti Library for studies published in English or Chinese between 1999 and September 2024. Among 524 identified articles, two RCTs met the inclusion criteria. Both demonstrated that structured self-management interventions led to improvements in overall quality of life and reductions in anxiety and depression symptoms. This review provides preliminary evidence that self-management interventions can benefit head and neck cancer patients. Although the number of studies is limited, findings suggest that individualized education and nurse-led support may enhance survivorship outcomes. Future research should focus on developing standardized, evidence-based self-management models validated in large-scale trials.

Systematic follow-up protocols, often including regular imaging, are an essential component of posttreatment care for head and neck cancer, aimed at the early detection of disease relapse and mitigating treatment-related morbidity. However, there is no consensus on the optimal length of follow-up and the value of imaging in surveillance. Most head and neck cancer recurrences occur within 1-2 years after treatment. After 2 years, the recurrence rate decreases significantly, and after 3 years, recurrences are infrequent. Most of the recent studies suggest that prolonged scheduled follow-up programs are not necessary, as asymptomatic salvageable late recurrences are rare. Imaging surveillance for the early detection of otherwise undetected recurrences is supported by many studies, although its impact on survival remains unclear. Recent literature emphasizes intensive follow-up programs during 1-2 years, as well as patient education for self-observation of alarming symptoms. Prolonged surveillance programs after 2-3 years may not be effective in detecting asymptomatic recurrences. While personalized surveillance based on risk factors is suggested, a lack of strict evidence hampers stratification. Imaging may be of value in detecting early asymptomatic recurrences at least up to 2 years, but disagreement exists regarding its utility in improving survival.

To estimate the number of cancer-related deaths that could be attributed to spatial disparities in survival. Cohort study of cancer registry data. Australia, 1 January 2010 to 31 December 2019. The numbers and percentages of cancer-related deaths attributable to spatial disparities in survival were estimated by calculating the numbers of cancer-related deaths that would have occurred if all areas in Australia met or exceeded a benchmark 5-year survival rate. This benchmark corresponded to the survival rate of the area with survival better than 80% of all areas, with "area" referring to residential location at diagnosis. Of all 289 075 cancer-related deaths in Australia in 2010-2019, 33 892 (11.7%) were attributable to spatial disparities in survival. Although numbers were greatest in major cities, as remoteness and area disadvantage increased, the percentages of cancer-related deaths attributable to spatial disparities in survival increased. Of all cancer-related deaths in remote areas and the most socio-economically disadvantaged areas, 1569 of 5208 (30.1%) and 13 469 of 66 775 (20.2%) deaths were attributable to survival disparities, respectively. The highest numbers and percentages of attributable cancer deaths in remote areas were for rare cancers (529/1809 [29.3%]), lung cancer (300/1298 [23.1%]) and head and neck cancers (162/370 [43.8%]). In the most disadvantaged areas, rare cancers (3070/20 512 [15.0%]) and lung cancer (2640/18 057 [14.6%]) had the highest numbers of attributable cancer deaths. These findings quantify the impact of spatial disparities in survival and highlight the need for equitable access to diagnostic and treatment services across Australia.

Exploring minimally invasive prognostic markers in head and neck squamous cell carcinoma is of value [...]

This cross-sectional study evaluated the quality of information on radiotherapy-related oral mucositis (OM) available on the YouTube platform in Brazil. The first 200 videos retrieved using the keywords "boca ferida radioterapia" were analyzed, excluding those shorter than 1min, longer than 15min, or unrelated to the topic. Technical data was collected, and six variables were assessed: definitions of head and neck cancer, radiotherapy, and OM; along with OM frequency, symptoms, and prevention/treatment options. Videos were categorized as 'poor' (score 1-2 on ≥ 1 variable), 'average' (score 3 on all variables), or 'good' (score 4-5 on ≥ 1 variable with no scores 1 or 2). Of the 104 videos analyzed, 51.0% were produced by doctors and 85.6% were aimed at the lay public. Most videos lasted 1-9min (87.5%), with 10,001-100,000 views (32.0%), ≤ 1,000 likes (54.4%), and ≤ 100 comments (66.3%). Overall, 10.6% (n = 11) were classified as 'poor' due to the presence of misinformation. An additional 32.7% (n = 34) were rated 'average' for failing to address any of the assessed variables. The majority, 56.7% (n = 59), were rated 'good' as they provided at least one accurate and comprehensive information and contained no misinformation. While few videos on radiotherapy-related OM in Brazil presented incorrect information, a significant number were incomplete. This highlights an opportunity to improve the content to provide the public with more comprehensive information.

Accurate prediction of treatment outcomes is crucial for personalized treatment in head and neck squamous cell carcinoma (HNSCC). Beyond one-year survival, assessing long-term enteral nutrition dependence is essential for optimizing patient counseling and resource allocation. This preliminary study aimed to predict one-year survival and feeding tube dependence in surgically treated HNSCC patients using classical machine learning. This proof-of-principle retrospective study included 558 surgically treated HNSCC patients. Baseline clinical data, routine blood markers, and MRI-based radiomic features were collected before treatment. Additional postsurgical treatments within one year were also recorded. Random forest classifiers were trained to predict one-year survival and feeding tube dependence. Model explainability was assessed using Shapley Additive exPlanation (SHAP) values. Using tenfold stratified cross-validation, clinical data showed the highest predictive performance for survival (AUC = 0.75 ± 0.10; p < 0.001). Blood (AUC = 0.67 ± 0.17; p = 0.001) and imaging (AUC = 0.68 ± 0.16; p = 0.26) showed moderate performance, and multimodal integration did not improve predictions (AUC = 0.68 ± 0.16; p = 0.38). For feeding tube dependence, all modalities had low predictive power (AUC ≤ 0.66; p > 0.05). However, postsurgical treatment information outperformed all other modalities (AUC = 0.67 ± 0.07; p = 0.002), but had the lowest predictive value for survival (AUC = 0.57 ± 0.11; p = 0.08). Clinical data appeared to be the strongest predictor of one-year survival in surgically treated HNSCC, although overall predictive performance was moderate. Postsurgical treatment information played a key role in predicting tube feeding dependence. While multimodal integration did not enhance overall model performance, it showed modest gains for weaker individual modalities, suggesting potential complementarity that warrants further investigation.

Quantify the anatomic variation of the ansa cervicalis and evaluate neurostimulation of the infrahyoid musculature. Intraoperative physiology study. Tertiary referral center. Adult patients undergoing lateral neck dissection including level IV for head and neck cancer were recruited. Ansa cervicalis plexus branches were documented during surgical dissection. In a subset of participants, an electrode was placed on branches of the common sternothyroid trunk innervating the sternothyroid and sternohyoid muscles. Hyolaryngeal excursion with neurostimulation was recorded. Measurements were collected from 39 of 50 participants. Reasons for intraoperative exclusion included significant radiation fibrosis (n = 4), nodal disease burden (n = 3), and surgeon preference (n = 4). The mean lengths of the common sternothyroid trunk and sternothyroid branch were 37.6 ± 15.0 mm and 20.4 ± 8.1 mm, respectively. Their respective mean diameters were 2.1 ± 0.7 mm and 1.5 ± 0.5 mm. The distance from sternothyroid branch muscle insertion to the sternum varied substantially (12.8 ± 14.8 mm). Nine patients underwent neurostimulation of the common sternothyroid trunk. The amplitude of first observed muscle contraction was 0.35 ± 0.18 mA and maximal was 0.57 ± 0.40 mA, during which the hyolaryngeal complex descended by 13.6 ± 4.6 mm. In patients with anatomy amenable to neurostimulation of other nerve branches, stimulation of the common sternothyroid trunk produced the greatest hyolaryngeal descent (P < .05). The minor variability observed in ansa cervicalis nerve diameter across patients and branches supports the feasibility of a standardized electrode design for an implantable neurostimulation device. Stimulation of the common sternothyroid trunk resulted in the greatest hyolaryngeal descent, highlighting its value as a potential neuromodulation target.

To evaluate super-resolution ultrasound (SRUS) for characterizing microvascular morphology and hemodynamics in metastatic versus reactive cervical lymph nodes (LNs), with the aim of improving metastatic detection and reducing unnecessary biopsies. In this prospective study, 166 patients with histopathologically confirmed cervical LNs (77 metastatic, 89 reactive) underwent conventional ultrasound and contrast-enhanced SRUS (CE-SRUS) using a commercial US system and SonoVue® microbubbles. Quantitative SRUS parameters vascular density (VD), fractal dimension (FD), flow-weighted vascular density (FWVD), perfusion index (PI), velocity entropy (Vel Entropy), minimum velocity (Vmin) were extracted from whole-LN ROIs. Diagnostic performance was assessed via receiver operating characteristic (ROC) analysis and multivariate logistic regression. Metastatic LNs showed significantly higher VD (0.482 ± 0.073 vs. 0.405 ± 0.168, p < 0.001), FD (1.678 ± 0.070 vs. 1.626 ± 0.098, p < 0.001), FWVD (1.784 ± 0.592 vs. 1.495 ± 0.813, p = 0.013), PI (12.617 ± 2.563 vs. 10.369 ± 5.006, p < 0.001), and Vel Entropy (0.922 ± 0.092 vs. 0.796 ± 0.199, p < 0.001), but lower Vmin (2.572 ± 2.200mm/s vs. 2.645 ± 2.800mm/s, p = 0.017) compared to reactive LNs. Univariate ROC top performers included Dir Entropy (AUC = 0.723) and VD (AUC = 0.689). Multivariate analysis identified VD (OR = 1.046, p = 0.001), Vmin (OR = 0.525, p = 0.003), Velocity Variance (Vel Var) (OR = 1.973, p = 0.016), Vel Entropy (OR = 4.674, p = 0.042), and PI (OR = 2.481, p = 0.018) as independent predictors. The combined model achieved superior diagnostic performance (AUC = 0.813, 95% CI: 0.748-0.879; sensitivity = 76.6%, specificity = 79.8%; p < 0.001). SRUS enables non-invasive, high-resolution quantification of microvascular alterations in metastatic LNs. A multivariate model demonstrates excellent discriminative power, demonstrating significant potential to improve preoperative assessment and biopsy guidance in head and neck cancer.

For patients with head and neck cancer (HNC), radiation therapy is associated with short-term, chronic, and late-onset dysphagia [1-3]. Swallowing exercises and oral intake during radiation may reduce dysphagia shortly after radiation [4-6]. The purpose of this study was to explore the relationship between exercise adherence and feeding tube use and one-year swallowing outcomes. Secondary analysis of RCT of swallowing therapy during definitive radiation-based HNC treatment. Adherence was defined as completing at least 50% of prescribed swallowing exercises during radiotherapy. Feeding tube use was prospectively collected. Outcome measures included the MD Anderson Dysphagia Inventory, Performance Status Scale - Head and Neck, Functional Oral Intake Scale, Penetration Aspiration Scale, Modified Barium Swallow Impairment Profile, and Dynamic Imaging Grade of Swallowing Toxicity scores. One-year follow-up data was available for 64 participants. Adherence criteria was met by 26 participants (41%) while feeding tube use (during treatment) was present in 8/64 participants (12%); only 1 patient had a feeding tube at one year. Adherence was associated with more normal MDADI scores one-year post-treatment (91 vs. 80: p = 0.003), as well as higher PSS normalcy of diet scores (p = 0.03). Feeding tube use was associated with worse maximum PAS scores (p < 0.001), DIGEST scores (Safety p = 0.04; overall grade p = 0.01), and MBS-ImP pharyngeal composite scores (p = 0.008). Adherence to swallowing exercises during radiation therapy is associated with better patient perceived swallow function and diet scores while avoidance of feeding tube placement is associated with better physiologic swallow function one year following radiation therapy.

Causal relationships between cerebrospinal fluid metabolites, immune cell traits, and head and neck cancers.

The Incidence of Avid Lesions in Head and Neck Cancer Patients Undergoing Positron Emission Tomography-Computed Tomography Scanning.

Radiation therapy (RT), a primary treatment for head and neck cancer (HNC), increases the risk of radiation-induced carotid stenosis (RICS). This study examines the progression of carotid artery total occlusion (CATO) in patients with HNC after RT, focusing on low-density plaque (LDP) as a predictor, an aspect underexplored in prior research. A retrospective cohort study assessed 44 patients with HNC who underwent RT, using 2021 follow-up data. Carotid stenosis progression was quantified via CT scans before and after LDP detection. Patients with irregular follow-up or RT within 2 years, insufficient for long-term evaluation, were excluded. CATO occurred in 11 patients (25%) and 12 vessels (14.3%), with a median onset of 12.6 years (interquartile range [IQR], 7.6-22.5) after RT. The stenosis progression rate increased significantly from 0.00%/year (IQR, 0.0%-1.0%) before LDP detection to 4.7%/year (IQR, 3.4%-8.1%) afterward (P < .001), with a marked acceleration to 14.8%/year (IQR, 9.6%-24.0%) in the CATO group. Neither calcification nor age at RT was significantly associated with CATO, reinforcing LDP as a critical high-risk marker. This study identifies LDP as a critical predictor of accelerated RICS, proposing a novel biphasic progression model with a slow phase before LDP detection and a rapid phase thereafter. Calcification showed no significant association with RICS progression. These findings support intensified surveillance, such as annual CT scans, and timely interventions to prevent occlusion in high-risk patients.

Obstructive sleep apnea (OSA) is a disorder with significant health implications. Variations in upper airway anatomy and pharyngeal tone are factors that predispose patients to OSA. Oropharyngeal cancer (OPC) may increase the risk of OSA due to treatment-induced changes in the upper airway. This scoping review aims to assess the prevalence of OSA in OPC patients post-treatment. A search was conducted across multiple databases, including PubMed, Embase, and Cochrane Library, to identify studies reporting the prevalence of OSA in OPC patients post-treatment (including surgery, radiation, and/or chemoradiation). Studies were screened for eligibility by two reviewers. Inclusion criteria required studies to use standardized diagnostic criteria for OSA and provide prevalence data specifically for post-treatment OPC patients. The search identified 788 studies: 30 underwent full-text review, and 13 studies with 373 head and neck cancer (HNC) patients met inclusion criteria. The majority of studies did not disaggregate data for OPC from other subsites; one study provided sufficient data on OSA prevalence in OPC patients post-treatment. Five studies reported AHI changes pre- and post-treatment with a mean change of 5.4 events/h with only 2 studies reporting significant changes in OSA rates. Sleep-related symptoms were captured in 11 studies with 2 comparing pre- and post-treatment. Despite the growing recognition of OSA as a potential comorbidity in cancer survivors, the literature does not adequately address the prevalence of OSA in OPC patients post-treatment. This highlights the need for future studies targeting OSA prevalence in this population using standardized diagnostic methods and reporting criteria.

To investigate the diagnostic profile of early (i.e., < 6 months of treatment) and late (i.e., ≥ 6 months of treatment) radiation-associated dysphagia (RAD) in patients with head and neck cancer. The literature was queried from inception to July 19, 2024. Outcomes included patient-reported outcome measures, aspiration prevalence, pharyngoesophageal stricture rate, and gastric tube presence. Data were collected at various time points from baseline up to 24 months post-treatment; longer-term data beyond 24 months was descriptively summarized. Meta-analysis of continuous measures (mean) and proportions (%) with 95% confidence intervals (CI) was performed. Of 2881 abstracts identified, 99 studies (N = 15 578 patients) were included. Mean age was 58.4 years; 78.9% of patients were male. M.D. Anderson Dysphagia Inventory composite scores were 71.2 (CI: 66.8-75.6) at 3 months and 82.8 (CI: 79.2-86.3) at 24 months, signifying improvement in swallowing-related quality of life. Aspiration prevalence was 28.4% (CI: 11.6-49.1) at 3 months and 8.8% (CI: 0.13-28.7) at 24 months. Stricture rate was 21.2% (CI: 9.7-15.2) at 6 months and 9.1% [CI: 3.0-17.9] at 24 months. Gastric tube presence declined from baseline (44.5% [CI: 36.8-52.4]) to 6 months (12.3% [CI: 9.7-16.6]) and fluctuated from 1 to 10 years post-treatment (range: 4.14% [CI: 2.7-5.9] to 9.17% [CI: 5.5-14.2]). RAD severity peaks within 3 months post-treatment, with improvement by 6 months. However, even at 2 years post-treatment, a substantial number of patients continue to experience clinically significant dysphagia. These findings highlight the persistent burden of RAD, underscoring the need for proactive longer-term dysphagia evaluation and management in this population.

Cisplatin remains the cornerstone radiosensitizer for definitive and adjuvant chemoradiation in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). However, despite decades of clinical use, many practical aspects of cisplatin administration remain unstandardized in clinical practice and trials. Drawing on the collective experience of the NRG Oncology Head and Neck Working Group, this consensus manuscript provides practical guidance on the administration of cisplatin during radiation therapy. We review and propose recommendations regarding the timing of chemotherapy and radiation initiation, premedication and hydration regimens by dose, monitoring and grading of cisplatin-induced ototoxicity, and management strategies during cisplatin shortages. Our guidance is informed by clinical trial protocols, retrospective and prospective data, and multidisciplinary expert consensus. We emphasize the importance of protocol flexibility to support equitable trial accrual, minimize treatment delays, and improve patient-centered outcomes. This manuscript offers a unified framework to optimize the use of cisplatin in chemoradiation protocols, improve adherence, reduce toxicity, and preserve oncologic efficacy. Our recommendations are particularly timely in the context of evolving clinical practices and recent cisplatin shortages. Insights from the NRG Oncology collaborative group aim to inform future trial designs and clinical practice guidelines, ensuring consistent and equitable care for patients with head and neck cancer.

Historical evidence demonstrated that delays or interruptions in radiotherapy (RT) are associated with poorer oncologic outcomes in head and neck squamous cell carcinoma (HNSCC). Substantial concerns arose during the COVID-19 pandemic, when treatment schedules were frequently disrupted. To determine the association of RT interruptions with locoregional failure (LRF) and overall survival (OS). This retrospective review and secondary analysis of 3 randomized clinical trials (NRG/RTOG 0129, 0522, and 1016) included patients enrolled in the trials who were treated with RT. Patients with HNSCC were grouped as (1) p16-positive oropharynx (p16+ OPSCC) and (2) p16-negative oropharynx and all other subsites regardless of p16 status (called locally advanced HNSCC [LAHNSCC])). Cox proportional hazards models were fit to assess the association of an RT interruption (binary model) and length of RT interruption (continuous model) with LRF and OS. Presence of RT interruption. LRF and OS. There were 1549 patients (200 female patients [12.9%]; mean [SD] age, 57 [6] years; 1048 p16+ OPSCC [67.7%]; 501 LAHNSCC [32.3%]) who were included in the binary model; 439 (28.3%) had RT interruption. There were 1083 patients (69.9%) with available length of RT interruption (continuous model). A binary RT interruption was associated with hazard ratios (HRs) of 1.04 (95% CI, 0.90-1.36) for LRF and 1.22 (95% CI, 0.99-1.50) for OS. As a continuous predictor, each 7-day interruption corresponded to HRs of 1.45 (95% CI, 1.12-1.89) for LRF and 1.41 (95% CI, 1.07-1.86) for OS. Analyses did not indicate effect modification by p16 status, and results are presented from models that estimated the effect of RT interruption across both groups. Using covariate-adjusted predictions from models that included clinical and tumor characteristics, a mean 7-day interruption in RT was associated with a 3-year LRF decrement of 4.1% in p16+ OPSCC and 9.1% in LAHNSCC. Predicted 3-year LRF detriment due to RT interruption ranged from 2.0% for a patient with non-T4, non-N3, p16+ OPSCC to 11.2% for a patients with LAHNSCC with a T4N3 p16-negative cancer. The secondary analysis suggests that RT treatment interruptions may be negatively associated with LRF and OS in HNSCC, but the magnitude of the association varies depending on p16 status and clinical characteristics. While treatment interruptions should globally be discouraged, patients with LAHNSCC or higher-stage disease may be most affected. ClinicalTrials.gov Identifiers: NCT00047008; NCT00265941; NCT01302834.

Recurrent oropharyngeal cancer (rOPC) presents challenging treatment decision-making. Toxicity from previous treatment, coupled with potential functional and quality of life (QoL) morbidity of further treatment(s) can influence decision-making regarding curative and non-curative treatment. To investigate swallowing and QoL outcomes, treatment-related priorities, and patient experience before and after rOPC treatment. Longitudinal, multicentre, mixed method study. Outcomes included the MD Anderson Dysphagia Inventory (MDADI), Performance Status Scale for Head and Neck Cancer (PSS-HN), the University of Washington QoL Questionnaire (UWQoLv4), the Chicago Priority Scale (CPS) and semi-structured interviews. The sample included 37 participants (prospective n = 25, retrospective n = 12, females n = 6) with a median age of 63 (range 41-88). The majority (n = 21) had curative intent treatment (surgery n = 20 or radiation n = 1). The remainder had non-curative intent immunotherapy (n = 14) or chemotherapy (n = 2). Swallowing and QoL were impaired at baseline; median MDADI composite score: 60 (IQR: 52.15-81.75), median PSS- HN normalcy of diet: (NoD): 50 and UWQoLv4 global health score (GHS): 60 (IQR 40-60). The PSS-HN NoD score deteriorated to 40 at six months. The MDADI and UWQoL data remained impaired. Triangulation with qualitative data revealed agreement with the PSS data and provided context for the relatively stable QoL. Being cured of cancer and living as long as possible remained the key priorities at all timepoints. In this study swallowing deteriorated with treatment for rOPC. Treatment-related priorities remained focused on cure or survival. If the treatment-related goal was achieved, patients adapted and experienced at least stable QoL regardless of swallowing status.

Head and neck squamous cell cancers (HNSCC) are a clinically and biologically diverse group of malignancies with limited tools for real-time monitoring and early detection of recurrence. Liquid biopsy strategies-particularly the analysis of circulating tumour cells (CTCs) and circulating tumour DNA (ctDNA)-have emerged as promising, minimally invasive biomarkers to capture real-time tumour dynamics. This review explores cellular and molecular processes that facilitate the release and survival of CTCs and ctDNA in the circulation in HNSCC. We also address the clinical relevance of CTCs and ctDNA in the prognosis, treatment response, and detection of minimal residual disease in HNSCC. Although integrating liquid biopsies into clinical care is limited by lack of standardisation, biological variability, and workflow challenges, CTCs and ctDNA have great potential to revolutionise HNSCC patient care with real-time and tailored interventions.

Head and neck squamous cell carcinoma (HNSCC) remains a treatment challenge, with frequent recurrences following localized disease and guarded outcomes in recurrent/metastatic (R/M) settings. While cytotoxic therapy and immune checkpoint inhibitors (ICIs) have produced incremental survival benefits, many patients still exhibit limited response or acquire resistance to treatment, highlighting a critical need for more personalized and novel therapeutic strategies. This review discusses personalized therapy approaches in HNSCC from 2020 to 2025, focusing on immune checkpoint blockade and newer therapeutic modalities. Additionally, this review highlights key biomarkers that are currently being evaluated for predictive and prognostic value in HNSCC. The literature was sourced through PubMed, Google Scholar and conference abstracts from ASCO, ESMO, and AACR, covering publications from January 2020-June 2025, with a focus on peer-reviewed trials and translational studies in human subjects. The future of HNSCC treatment lies in the development of novel treatment combinations integrating immunotherapy using immune checkpoint blockade with newer therapeutic approaches. Understanding which agents to use, and when in the course of treatment, stands as a challenge that will shape the future of precision therapy for HNSCC, with integration of biomarkers promising to guide this transition.

Dose-dependent taste dysfunction in head and neck cancer patients receiving radiotherapy.