复发性或不可切除头颈癌的光免疫治疗：临床结局与围手术期气道管理

文献信息

中文摘要

目的： 本研究旨在评估光免疫治疗（PIT）用于复发性或不可切除头颈癌的临床结局，探索与治疗反应相关的特征，并评估围手术期气道管理。
方法： 这项回顾性研究纳入2023年2月至2025年10月期间在单一机构连续接受PIT的11例患者。根据最佳总体反应对患者进行分类；分析临床特征、既往治疗和围手术期气道管理。
结果： 6例患者（55%）达到完全缓解，而5例出现疾病进展。6个月总生存率和无进展生存率分别为81.8%和72.7%；中位无进展生存期为10.3个月，中位总生存期未达到。完全缓解者主要表现为口腔或鼻窦肿瘤，并且更早接受PIT且既往治疗较少，而无反应者则接受了大量化疗、放疗和免疫检查点抑制剂预处理。逐步气道策略包括在术后第1天（POD1）重新评估喉部所见，随后拔管、继续观察至POD2，或必要时行气管造口术。该方法确保了安全管理，尽管一名患者在长时间插管后出现了短暂的ICU获得性肌无力。
结论： 在精心选择的患者中引入PIT——包括异时性第二原发肿瘤或放化疗后微小残留病灶的患者——可能改善局部控制。一种逐步的、基于方案的气道管理方法，结合POD1和POD2的重新评估，可确保安全性，同时尽量减少插管相关并发症。

英文摘要

OBJECTIVE: This study aimed to evaluate the clinical outcomes of photoimmunotherapy (PIT) for recurrent or unresectable head and neck cancer, explore characteristics associated with treatment response, and assess perioperative airway management.
METHODS: This retrospective study included 11 consecutive patients undergoing PIT at a single institution between February 2023 and October 2025. Patients were classified by best overall response; clinical characteristics, prior treatments, and perioperative airway management were analysed.
RESULTS: Six patients (55%) achieved a complete response, whereas five experienced progressive disease. Six-month overall and progression-free survival rates were 81.8% and 72.7%, respectively; median progression-free survival was 10.3 months, and median overall survival was not reached. Complete responders predominantly presented with oral or sinonasal tumours and received PIT earlier with fewer prior treatments, whereas non-responders were heavily pretreated with chemotherapy, radiotherapy, and immune checkpoint inhibitors. A stepwise airway strategy involved reassessing laryngeal findings on postoperative day 1 (POD1), followed by extubation, continued observation until POD2, or tracheostomy if required. This approach ensured safe management, although one patient developed transient intensive care unit (ICU)-acquired weakness following prolonged intubation.
CONCLUSIONS: PIT introduction in carefully selected patients-including those with metachronous second primary tumours or minimal residual disease following chemoradiotherapy-may improve local control. A stepwise, protocol-based airway management approach, incorporating reassessment on POD1 and POD2, ensures safety whilst minimising intubation-related complications.