What is the treatment for squamous cell carcinoma with a single positive lymph node?

From the Guidelines

The treatment for squamous cell cancer with one positive lymph node should involve a multimodal approach, including surgery followed by adjuvant radiation therapy or concurrent chemoradiation, as this approach has been shown to improve locoregional control and overall survival 1. The primary treatment typically involves complete removal of the tumor with clear margins and lymph node dissection of the affected area. Following surgery, adjuvant radiation therapy is usually recommended to target the primary tumor site and regional lymph nodes, typically delivered at doses of 60-66 Gy over 6-7 weeks, using intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) 1. For higher-risk cases, concurrent chemoradiation may be used, with cisplatin (100 mg/m² every 3 weeks) being the standard chemotherapy agent, as it has been shown to increase locoregional control and disease-free survival compared to radiation therapy alone 1. In some cases, particularly for head and neck squamous cell carcinoma, immunotherapy with pembrolizumab (200 mg every 3 weeks) might be added to the regimen, especially for patients with recurrent or metastatic disease expressing PD-L1 (CPS 1) 1. Post-treatment surveillance is essential, with follow-up examinations every 1-3 months for the first year, then every 2-6 months for the second year, and annually thereafter. Key considerations in the treatment plan include:

• The tumor location, size, and depth
• The patient's overall health and performance status
• The presence of any high-risk features, such as perineural infiltration or extracapsular extension
• The patient's preference and values regarding treatment options and potential side effects. The treatment plan should be individualized and discussed in a multidisciplinary team (MDT) setting, including surgeons, radiation oncologists, medical oncologists, and other supportive specialties 1.

From the Research

Treatment Options for Squamous Cell Cancer with One Lymph Node Positive

• The treatment for squamous cell cancer with one lymph node positive can involve various chemotherapy regimens, including carboplatin, 5-fluorouracil, cisplatin, and docetaxel 2, 3, 4, 5.
• A study comparing carboplatin with 5-fluorouracil vs. cisplatin as concomitant chemoradiotherapy for locally advanced head and neck squamous cell carcinoma found that cisplatin resulted in a higher chemotherapy completion rate and better overall survival rates 2.
• Another study evaluated the combination of paclitaxel, cisplatin, and 5-fluorouracil for patients with advanced or recurrent squamous cell carcinoma of the head and neck, and found that the regimen was feasible with encouraging outcomes and activity in patients with recurrent or metastatic disease 3.
• Docetaxel, cisplatin, and 5-fluorouracil-based induction chemotherapy has also been studied in patients with locally advanced squamous cell carcinoma of the head and neck, with results showing that the regimen is effective and has a low rate of significant morbidity 4.
• A comparison of carboplatin/5-fluorouracil and cisplatin/5-fluorouracil regimens for metastatic and recurrent head and neck squamous cell carcinoma and nasopharyngeal carcinoma found that carboplatin/5-fluorouracil is not inferior to cisplatin/5-fluorouracil in terms of efficacy, but has a higher rate of treatment-related deaths 5.
• A recent pilot study investigated the efficacy and safety of 5-fluorouracil/cisplatin/cetuximab therapy as a candidate regimen for induction chemotherapy in advanced head and neck squamous cell carcinoma, and found that the regimen has comparable efficacy to docetaxel/cisplatin/5-fluorouracil with less toxicity 6.

Chemotherapy Regimens

• Carboplatin and 5-fluorouracil: this regimen has been studied as an alternative to cisplatin and 5-fluorouracil, with results showing that it is not inferior in terms of efficacy, but has a higher rate of treatment-related deaths 5.
• Cisplatin and 5-fluorouracil: this regimen is considered the standard of care for locally advanced head and neck squamous cell carcinoma, but has been associated with higher rates of toxicity 2, 3, 5.
• Docetaxel, cisplatin, and 5-fluorouracil: this regimen has been studied as an induction chemotherapy regimen for locally advanced squamous cell carcinoma of the head and neck, with results showing that it is effective and has a low rate of significant morbidity 4.
• Paclitaxel, cisplatin, and 5-fluorouracil: this regimen has been studied in patients with advanced or recurrent squamous cell carcinoma of the head and neck, with results showing that it is feasible with encouraging outcomes and activity in patients with recurrent or metastatic disease 3.
• 5-fluorouracil, cisplatin, and cetuximab: this regimen has been studied as a candidate regimen for induction chemotherapy in advanced head and neck squamous cell carcinoma, with results showing that it has comparable efficacy to docetaxel/cisplatin/5-fluorouracil with less toxicity 6.