• Michael Pogorzelski and Viktor Grünwald.
• Innere Klinik (Tumorforschung), Westdeutsches Tumorzentrum, Universitätsklinikum Essen.
• Dtsch. Med. Wochenschr. 2019 Dec 1; 144 (24): 1691-1696.

AbstractThe standard of care in squamous cell carcinoma of the head and neck (SCCHN) has recently undergone some major shifts in prevention, diagnostics, staging, prognostication and therapy.Prevention: Subtypes of the human papilloma virus (HPV) have been identified as causative agent for HPV-driven oropharyngeal carcinomas nearly two decades ago. Vaccination against HPV is now recommended for all girls and boys at the age of 9 to 14 years by the Standing Committee on Vaccination at the Robert Koch Institute (STIKO).Diagnostics: 18F-FDG PET/CT allows for a reduction of surgical procedures and is now reimbursed by the german health care system in certain indications. In N2/N3-disease after definitive chemoradiotherapy a FDG PET/CT is indicated to prevent neck dissection in PET negative patients. Moreover, a FDG PET CT is indicated in case of suspected recurrence of laryngeal carcinoma and as staging procedure in patients with cervical manifestation of CUP syndrome.Staging/prognostication: The favorable prognosis of HPV-driven oroparhyngeal carcinomas is now reflected by the 8th edition of the TNM classification. Therapeutic decisions should still be based on the established criteria of the 7th edition.Locally advanced disease: Treatment de-intensification strategies for HPV positive oropharyngeal carcinomas are currently evaluated. So far, the already published trials have reported a disadvantage for less intensive regimens. Therefore, de-intensification should not be practiced in current standard of care.Palliative systemic therapy: Checkpoint inhibitors nivolumab and pembrolizumab are the new standard of care after progression on platinum based therapies. In the Keynote-048 trial, treatment with either pembrolizumab alone (CPS > 1) or its combination with platin+ 5-flourouracil was superior to the current first line standard PFC.© Georg Thieme Verlag KG Stuttgart · New York.

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