Improving the multidisciplinary therapeutic management of head and neck squamous cell carcinoma: Consensus statements from an Italian expert panel.

Marco Ravanelli, Maria Grazia Ghi, Stefania Vecchio, Pierluigi Bonomo, Francesco Perri, Andrea Botticelli, Salvatore Alfieri, Laura Deborah Locati, Paolo Bossi, Patrizia Morbini, Francesca De Felice, Massimo Ghiani, Gabriele Molteni, Vittorio Rampinelli, Valentino Valentini

Journal: Critical reviews in oncology/hematology 2025;210():104709

PMID: 40154651

Free Full Text on Elsevier Science View on PubMed

Abstract

OBJECTIVE

The management of recurrent and/or metastatic (RM) head and neck squamous cell carcinoma (HNSCC) poses significant clinical challenges. This study aimed to develop expert consensus statements to improve the multidisciplinary management of RM HNSCC.

METHODS

A multidisciplinary team of 39 Italian experts, including medical oncologists, surgeons, radiation oncologists, radiologists, and pathologists, employed the Delphi method to achieve consensus on critical aspects of RM HNSCC management. Two rounds of surveys were conducted, focusing on five key areas: PD-L1 testing, treatment selection, treatment refinement, patient care, and special clinical scenarios.

RESULTS

Consensus was reached on 43 out of 45 statements (96 %). Key recommendations included mandatory PD-L1 testing for guiding treatment selection, the use of immunotherapy in patients with a combined positive score ≥ 1, and the importance of considering patient fitness, disease characteristics, and potential treatment toxicities in decision-making. The panel emphasized integrating supportive care early in the treatment pathway and highlighted the need for multidisciplinary decision-making in cases of oligometastatic disease. Treatment strategies should prioritize both locoregional control and systemic therapy based on tumor biology and patient-specific factors.

CONCLUSIONS

These consensus statements provide guidance for optimizing the multidisciplinary management of RM HNSCC, emphasizing personalized treatment strategies, early supportive care, and the importance of clinical trials to address existing uncertainties.

Address: Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Milan, Pieve Emanuele 20072, Italy; IRCCS Humanitas Research Hospital, via Manzoni 56, Milan, Rozzano 20089, Italy. Electronic address: [email protected].; Head and Neck Cancer Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.; Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.; Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.; Department of Radiotherapy, Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy.; Oncology Unit 2, Veneto Institute of Oncology-IRCCS, Padua, Italy.; Oncology Unit, "Businco" Hospital, Cagliari, Italy.; Department of Otolaryngology - Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.; Unit of Pathology, E. O. Ospedali Galliera, Genova, Italy.; Head and Neck Clinical and Experimental Oncology Unit, INT IRCCS Fondazione G. Pascale, Naples, Italy.; Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Italy.; Radiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, Brescia, Italy.; Sapienza University of Rome, Rome, Italy.; Medical Oncolgy Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.; Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Medical Oncology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.

DOI: 10.1016/j.critrevonc.2025.104709