Surgical efficacy of locally advanced hypopharyngeal carcinoma after neoadjuvant immunotherapy

Objectives : This study aimed to explore the clinical efficacy of neoadjuvant immunotherapy in locally advanced hypopharyngeal carcinoma, and to assess the application value of minimally invasive treatment after tumour downstaging. Methods :The clinical data of 73 patients with locally advanced hypopharynx squamous carcinoma were retrospectively analysed.These patients received neoadjuvant immunotherapy at Tongren Hospital, Beijing, China, from January 2022 to September 2024. Statistical analyses were performed to determine the efficacy of the chemotherapy, adverse reactions, the choice of the subsequent therapeutic modalities, and prognosis of the patients. Results : 73 patients were included in this study. They all received 2 cycles of neoadjuvant immunotherapy and were evaluated by imaging after the end of treatment. Response was assessed as complete remission(CR) in 17 patients, partial response(PR) in 40, stable disease(SD) in 14, and progressive disease(PD) in 2. The overall disease control rate (DCR) was 97.3% and objective remission rate (ORR) was 78.1%. 44 patients did not receive surgical treatment, including 11 patients continued chemotherapy and 33 patients treated with radiotherapy after pathological complete remission (pCR). 29 patients received surgical treatment. The laryngeal preservation rate was 88.7%. Minimally invasive and open laryngeal function-preserving surgeries did not show significant differences in progression-free survival (PFS) and overall survival (OS) (P > 0.05). But there were statistically significant differences in the recovery of respiratory function and vocal function (P < 0.05). Conclusions :Neoadjuvant immunotherapy has demonstrated high efficacy and a good safety profile in patients with locally advanced hypopharyngeal squamous cell carcinoma. Transoral minimally invasive therapy provides an effective treatment strategy for patients with locally advanced hypopharyngeal carcinoma who responded well to neoadjuvan chemotherapy.