Head and Neck Cancer Salvage Surgery in the Era of Immunotherapy and Beyond: A Review.

Importance: Head and neck squamous cell carcinoma (HNSCC) is a challenging malignant condition associated with significant morbidity and mortality. Salvage surgery, in addition to other available treatment modalities, constitutes an important therapeutic intervention for locoregionally recurrent HNSCC, offering the potential for improved locoregional control and survival outcomes. However, the indications for salvage surgery remain diverse and poorly standardized, with reported 5-year survival outcome rates ranging from 10% to 61%. In recent years, the incorporation of immunotherapy into the management of recurrent and locally advanced HNSCC has shown promising potential. Although preoperative immunotherapy has resulted in improved outcomes in other malignant neoplasms, such as non-small cell lung cancer, its integration into HNSCC surgical protocols whether in the primary or salvage setting is still in its early stages. Early single-institution trials suggest combining immunotherapy with salvage surgery may enhance survival, reduce recurrence rates, and improve other outcomes for patients with recurrent or persistent HNSCC.

Observations: This review explores the evolving landscape of HNSCC salvage surgery in the era of immunotherapy by assessing current evidence, clinical implications, and future directions for this integrated approach.

Conclusions and relevance: Advances in immunotherapy and the development of future clinical trials incorporating immunotherapy in the HNSCC salvage setting have the potential to enhance patient selection and optimize surgical outcomes.