McLean Luke S, Lim Annette M, Webb Angela, Cavanagh Karda, Thai Alesha, Magarey Matthew, Fox Carly, Kleid Stephen, Rischin Danny
Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
Front Oncol. 2022 Jan 18;11:796197. doi: 10.3389/fonc.2021.796197. eCollection 2021.
Cutaneous squamous cell carcinoma (CSCC) of the head and neck can require complex and disfiguring surgery in order to achieve cure, which can be morbid and negatively impact patient quality of life. The management of advanced CSCC has been revolutionized by immunotherapy with current clinical trials also exploring its role in the neoadjuvant and adjuvant settings. Patients may decline morbid curative surgery, such as orbital exenteration, and the outcomes of immunotherapy use in this unique group of patients require further investigation.
We reviewed the records of 119 patients treated at a major Australian quaternary oncology centre with immunotherapy (either cemiplimab or pembrolizumab) for advanced CSCC.
We identified 7 patients recommended curative surgery involving orbital exenteration after multidisciplinary discussion, who declined surgery due to concerns about morbidity and/or disfigurement. All 7 patients demonstrated a response to treatment, and six avoided orbital exenteration. Two patients experienced pseudoprogression.
The management of CSCC can be complex and requires the input of a multidisciplinary team. Immunotherapy to avoid or reduce the extent of morbid definitive surgery is an emerging treatment option.
头颈部皮肤鳞状细胞癌（CSCC）可能需要进行复杂且毁容性的手术才能实现治愈，这可能会带来不良影响并对患者生活质量产生负面影响。免疫疗法彻底改变了晚期CSCC的治疗方式，目前的临床试验也在探索其在新辅助和辅助治疗中的作用。患者可能会拒绝进行如眼眶内容物剜除术等具有不良影响的根治性手术，而在这一特殊患者群体中使用免疫疗法的效果需要进一步研究。
我们回顾了澳大利亚一家大型四级肿瘤中心119例接受免疫疗法（西米普利单抗或帕博利珠单抗）治疗晚期CSCC患者的记录。
我们确定有7例患者在多学科讨论后被建议进行包括眼眶内容物剜除术在内的根治性手术，但由于担心手术的不良影响和/或毁容而拒绝手术。所有7例患者均对治疗有反应，其中6例避免了眼眶内容物剜除术。2例患者出现假性进展。
CSCC的治疗可能很复杂，需要多学科团队的参与。免疫疗法作为避免或减少具有不良影响的根治性手术范围的一种治疗选择正在兴起。
