Squamous cell carcinoma untreated for 2 years
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Natural History and Prognosis of Untreated Squamous Cell Carcinoma
Introduction to Squamous Cell Carcinoma (SCC)
Squamous cell carcinoma (SCC) is a type of cancer that arises from squamous cells, which are flat cells found in the skin and mucous membranes. When left untreated, SCC can have severe consequences, particularly in the head and neck region.
Survival Rates and Prognosis of Untreated SCC
The prognosis for patients with untreated head and neck SCC is extremely poor. A study involving 206 patients with untreated head and neck SCC revealed that the 1-year survival rates for cancers in the oral cavity, oropharynx, throat, and hypopharynx were 31%, 20%, 0%, and 3%, respectively, with a significant difference in survival rates (p<0.001)1. The median survival time for these patients was only 11 months, and 57.2% of the patients died within 12 months1. The T stage of the tumor was identified as the strongest predictor of survival time1.
Treatment Approaches and Outcomes
Neoadjuvant Immunotherapy
Neoadjuvant immunotherapy, which involves administering treatment before the main treatment, has shown promise in improving outcomes for SCC patients. A phase 2 clinical trial investigated the use of nivolumab alone or in combination with ipilimumab in patients with untreated oral cavity SCC. The study found that both treatment arms showed promising response rates, with a 1-year progression-free survival of 85% and overall survival of 89%2.
Induction Chemotherapy
Induction chemotherapy followed by locoregional treatment has been explored for locally advanced head and neck SCC. A phase II clinical trial compared two chemotherapy regimens followed by local therapy and found that the 2-year progression-free survival rates were 89% and 88% for the two regimens, respectively, showing a significant improvement compared to historical controls3.
Combined Radiotherapy and Chemotherapy
A randomized trial compared alternating radiotherapy and chemotherapy with radiotherapy alone in patients with unresectable head and neck SCC. The combined treatment group had significantly better 5-year overall survival (24% vs. 10%), progression-free survival (21% vs. 9%), and locoregional relapse-free survival (64% vs. 32%) compared to the radiotherapy-only group4.
Conclusion
Untreated squamous cell carcinoma, particularly in the head and neck region, has a very poor prognosis with low survival rates. However, various treatment strategies, including neoadjuvant immunotherapy, induction chemotherapy, and combined radiotherapy and chemotherapy, have shown promise in improving outcomes for patients with SCC. Early and aggressive treatment is crucial to enhance survival and quality of life for these patients.
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Most relevant research papers on this topic
Natural history of untreated squamous cell carcinoma of the head and neck
Untreated head and neck squamous cell carcinoma patients have an extremely unfavorable prognosis, with T stage being the strongest predictor for survival time.
Observational Study
Rigorous JournalNeoadjuvant Nivolumab or Nivolumab Plus Ipilimumab in Untreated Oral Cavity Squamous Cell Carcinoma: A Phase 2 Open-Label Randomized Clinical Trial.
Neoadjuvant nivolumab or nivolumab plus ipilimumab show promising rates of response in untreated oral cavity squamous cell carcinoma patients, supporting further neoadjuvant studies.
RCTRigorous Journal
Highly CitedWeekly paclitaxel, carboplatin, cetuximab, and cetuximab, docetaxel, cisplatin, and fluorouracil, followed by local therapy in previously untreated, locally advanced head and neck squamous cell carcinoma
Cetuximab-based induction chemotherapy and C-TPF followed by local therapy show a 20% improvement in 2-year progression-free survival compared to historical control in locally advanced head and neck squamous cell carcinoma patients.
RCTFive-year update of a randomized trial of alternating radiotherapy and chemotherapy compared with radiotherapy alone in treatment of unresectable squamous cell carcinoma of the head and neck.
Alternating radiotherapy and chemotherapy is more effective than radiotherapy alone in treating unresectable head and neck squamous cell carcinoma, with better overall survival, progression-free survival, and locoregional relapse-free survival.
RCTHighly CitedNeoadjuvant chemotherapy combined with radical surgery for stage IB2/IIA2 cervical squamous cell carcinoma: a prospective, randomized controlled study of 35 patients
Neoadjuvant chemotherapy combined with radical surgery is safe and feasible for stage IB2/IIA2 cervical squamous cell carcinoma, reducing tumor infiltration and improving patient quality of life, but does not improve 3-year/5-year survival rates.
RCTRigorous JournalT1-T2 squamous cell carcinoma of the glottic larynx treated with radiation therapy: relationship of dose-fractionation factors to local control and complications.
Higher doses and dose per fraction of radiation therapy improve local control in T1-T2 squamous cell carcinoma of the glottic larynx, with serious complications associated with T stage and increasing total dose and dose per fraction.
Observational StudyHighly CitedTirapazamine, cisplatin, and radiation versus cisplatin and radiation for advanced squamous cell carcinoma of the head and neck (TROG 02.02, HeadSTART): a phase III trial of the Trans-Tasman Radiation Oncology Group.
Tirapazamine combined with cisplatin and radiation does not improve overall survival in advanced head and neck cancer patients not selected for hypoxia.
RCT
Large Human TrialRigorous JournalHighly CitedTwo-year randomized controlled prospective trial converting treatment of stable renal transplant recipients with cutaneous invasive squamous cell carcinomas to sirolimus.
Conversion to sirolimus-based immunosuppression in renal transplant recipients with cutaneous invasive squamous cell carcinomas did not show a significant benefit in terms of SCC-free survival at 2 years.
RCTRigorous JournalHighly CitedSirolimus for Secondary Prevention of Skin Cancer in Kidney Transplant Recipients: 5-Year Results.
Sirolimus effectively reduces the occurrence of secondary skin cancers in kidney transplant recipients with previous cutaneous squamous cell carcinomas, maintaining antitumoral effect for 5 years.
RCTRigorous JournalTreatment of advanced squamous-cell carcinoma of the head and neck with alternating chemotherapy and radiotherapy.
Alternating chemotherapy with radiotherapy improves survival in advanced unresectable squamous-cell carcinoma of the head and neck compared to radiotherapy alone.
RCTHighly Cited