30-Second Takeaway
- Many Medicare LA-HNSCC patients on definitive RT get neither cisplatin nor any systemic therapy despite trial evidence.
- Global comorbidity and geriatric frailty—not discrete contraindications—shape real-world cisplatin use and toxicity risk.
- Preoperative MRI iENE in oral tongue SCC is confirmatory when positive but too insensitive to safely de-escalate treatment.
- AI-augmented imaging and noninvasive omics are rapidly emerging for oral cavity margins and unified-airway endotyping.
- New mechanistic data link IL-1 signaling, metabolic networks, and SARS-CoV-2 neurotropism to resistance and sensory morbidity.
Week ending April 11, 2026
Head & neck oncology, airway inflammation, and otology: concise updates with near-term practice relevance
Definitive RT for LA-HNSCC in Medicare rarely includes cisplatin or any systemic therapy
Among 3,548 SEER-Medicare patients with locoregionally advanced pharyngeal or laryngeal HNSCC treated with definitive RT, only 23.2% received cisplatin. Overall, 49.7% received no systemic therapy, and the proportion without systemic treatment increased over the study period. Renal failure, neuropathy, and hearing loss were associated with omitting cisplatin on univariable analysis. After multivariable adjustment, only higher Elixhauser comorbidity index remained linked to lower cisplatin use, reflecting global health status. These patterns suggest substantial underuse of concurrent systemic therapy beyond clear-cut contraindications in older patients.
Geriatric assessment reclassifies fitness and modifies therapy in older LA-HNSCC
This prospective multicenter study applied comprehensive geriatric assessment (CGA) to 101 ≥65-year-old LA-HNSCC patients considered for curative treatment. CGA categorized 33.7% as fit, 39.6% as vulnerable, and 26.7% as frail, refining initial impressions of fitness. Multidisciplinary plans changed after CGA in 11.8% of patients, and supportive-care strategies were more frequently emphasized. Severe adverse events were common; 30 patients required hospitalization for toxicity despite CGA-informed planning. At three months, most evaluated patients achieved complete response, indicating many older patients can tolerate curative therapy when appropriately selected.
MRI iENE has high specificity but poor sensitivity for ENE in oral tongue SCC
This retrospective study evaluated pre-treatment MRI in 224 upfront oral tongue SCC cases for nodal metastasis and pathological extranodal extension (pENE). MRI sensitivity and specificity for metastatic nodes were 52.73% and 99.09%, indicating strong rule-in but weak rule-out value. For any pENE, imaging sensitivity was 36.36% and specificity 93.55%, again favoring confirmation over exclusion. Major iENE had 27.78% sensitivity but 100% specificity and positive predictive value, missing most major ENE cases. Nodal matting, >2 mm perinodal fat stranding, and adjacent structure infiltration reliably indicated major pENE when present.
References
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Additional Reads
Optional additional studies from this edition.