Dachao gathering - Guo Wei, Hu Chaosu, Zhang Chenping professor to interpret the new version of the CSCO head and neck guide update disparate points, looking forward to the immune treatment.

Experts talked about the development status of head and neck cancer in China, immunotherapy, multidisciplinary comprehensive treatment, etc.on July 12, 2020, the China Society of Clinical Oncology (CSCO) head and neck cancer guidelines 2020 press conference and head and neck cancer precision / immunotherapy Summit Forum was successfully held. At the same time, the new version of CSCO head and neck cancer diagnosis and treatment guidelines (hereinafter referred to as the guidelines) was released.the update of the guide is based on the efforts of the CSCO head and neck cancer guidelines compilation group, based on evidence-based medicine evidence, taking into account the accessibility of diagnostic products, and absorbing new advances in precision medicine. After many discussions, it has become a "compass" for clinical diagnosis.we specially invite Professor Guo Ye of Dongfang Hospital Affiliated to Tongji University, Professor Hu chaosu of Tumor Hospital Affiliated to Fudan University, and Professor Zhang Chenping of the Ninth People's Hospital Affiliated to Shanghai Jiaotong University Medical College to express their opinions on the development status of head and neck cancer in China, immunization treatment and multidisciplinary comprehensive treatment.Click to watch a wonderful video about experts' introduction Professor Guo ye, deputy director of tumor medicine department and director of phase I clinical trial center, Dongfang Hospital Affiliated to Tongji University, Deputy Secretary General of Chinese society of Clinical Oncology, chairman of head and neck cancer committee of Chinese society of Clinical Oncology, deputy chairman of thyroid cancer Professional Committee of Chinese society of Clinical Oncology, head and neck cancer Professional Committee of Chinese Medical Association Deputy chairman: lymphoma Committee of China Geriatric Health Care Association vice chairman of lymphoma alliance of Chinese Clinical Oncology Society member of Youth Committee of cancer chemotherapy Professional Committee of China Anti Cancer Association Deputy chairman of cancer professional committee vice chairman of lymphoma Professional Committee of Shanghai anti cancer association? What are the important updates compared to the previous version? Prof. Guo ye: at present, the guideline has been updated to the third edition. The highlight of this year's guideline is the treatment of recurrent / metastatic head and neck squamous cell carcinoma.in the past, the clinical research data referred to in the guideline were all from the western population, but this year, more targeted research data based on the Chinese population, such as the change-2 study, showed that the Chinese population could benefit from the study.based on this, chemotherapy combined with cetuximab (targeted) is considered as the standard first-line treatment for recurrent / metastatic head and neck squamous cell carcinoma.at the same time, with the approval of PD-1 inhibitor, navulizumab, as a second-line treatment indication for recurrent / metastatic head and neck squamous cell carcinoma in China, the new edition of the guidelines recommended the first-line treatment of navulizumab by experts at grade I.in terms of recurrent / metastatic head and neck squamous cell carcinoma, the recommendations of the new edition of the guidelines have been synchronized with those of foreign countries, including the national comprehensive cancer network (NCCN) and the European Society of Oncology (ESMO).this update will certainly provide more valuable clinical practice guidance for Chinese doctors, especially physicians, and will further improve the treatment level of recurrent / metastatic head and neck squamous cell carcinoma in China, and provide good guidance for our future clinical research and all aspects of work.Q2: since the establishment of CSCO head and neck cancer committee in September 2018, it has been two years.as a leader in this field, do you have any expectations for the future development of the special committee and the whole process management of head and neck cancer in the future? Prof. Guo ye: CSCO head and neck cancer special committee is a relatively young team, but it has its own characteristics. The establishment of the special committee is combined with the multidisciplinary diagnosis and treatment mode of head and neck cancer. Its members cover a wide range of fields, including doctors in surgery, radiotherapy and oncology.in the future, the development of the society will continue the multi-disciplinary trend. For the diagnosis and treatment of head and neck tumors, "internal, external and radiation" treatment modes are indispensable.we need to strengthen communication for a long time in the future, which is different from other head and neck cancer societies. We have many interdisciplinary joint discussion links, which are very necessary and necessary.for the future, it is necessary to integrate the new technologies of various disciplines, including the progress of robotic surgery reported in today's meeting, and how to combine it with traditional radiotherapy in the future; the application of new radiotherapy technologies, as well as the combination with surgical operation and medical treatment; as well as the update of drug application, how to move forward the targeting and immunotherapy, especially for patients with early and late stage To improve the overall prognosis of patients All kinds of combinations need to be carried out under the framework of multidisciplinary diagnosis and treatment (MDT), including a series of prospective clinical studies, promoting the exchange and cooperation of new technologies, and realizing the trend of win-win cooperation.Prof. Hu chaosu, chief physician, Professor, doctoral supervisor, deputy director of radiotherapy department, Tumor Hospital Affiliated to Fudan University, director of nasopharyngeal carcinoma diagnosis and treatment center, Fudan University Chief expert of nasopharyngeal carcinoma, former chairman of NPC Professional Committee of China Anti Cancer Association, chairman of radiation oncology Committee of Shanghai Medical Association, member of radiation oncology society of Chinese Medical Association, standing member of neurooncology Committee of Chinese Anti Cancer Association, member of tumor radiotherapy Professional Committee of China Anti Cancer Association, vice chairman of NPC Professional Committee of Chinese society of clinical oncology Member: Vice Chairman of head and neck cancer Professional Committee of Chinese society of Clinical Oncology, standing member of cancer radiotherapy Professional Committee of China Anti Cancer Association, chairman of NPC Professional Committee of Shanghai anti cancer association. Q1: radiotherapy is the cornerstone of nasopharyngeal carcinoma treatment. Could you briefly introduce the new recommendations of radiotherapy in the new guidelines? Professor Hu chaosu: radiotherapy is the main treatment for nasopharyngeal carcinoma. This year, there are few updates in the radiotherapy field of the guide. The main aspects are as follows: first, the relationship between EB virus and nasopharyngeal carcinoma.Epstein Barr virus (EBV) plays an important role in the occurrence, development and prognosis of nasopharyngeal carcinoma. Therefore, the guideline emphasizes the role of detection of Epstein Barr virus in the diagnosis and treatment of nasopharyngeal carcinoma. Secondly, in terms of radiotherapy technology, three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are recommended, and intensity-modulated radiation therapy is more effective. Most domestic centers can also apply this technology Intensity modulated radiation therapy (IMRT) will be regarded as the main recommended treatment in the "guidelines"; thirdly, the traditional treatment of nasopharyngeal carcinoma is mainly combined with radiotherapy and chemotherapy. This year's guide was published in the New England Journal of medicine based on a phase III study [gemcitabine plus cisplatin (GP) regimen induction chemotherapy] carried out by Professor Ma Jun, cancer prevention and treatment center of Sun Yat sen University in 2019 GP regimen induction combined with concurrent chemoradiotherapy was recommended by grade I experts. this is a major change in recommendation. Fourth, endoscopic surgery is in full swing in patients with recurrent / metastatic nasopharyngeal carcinoma. For locally recurrent nasopharyngeal carcinoma, the new guidelines raise endoscopic surgery to the same recommended level as radiotherapy. Q2: in the new edition of the guidelines, immunotherapy is first recommended as a second-line / salvage treatment for distant metastatic nasopharyngeal carcinoma. What evidence-based medical evidence is the recommendation based on? Professor Hu chaosu: the application of immunotherapy is also in full swing. In this year's guidelines for second-line or salvage treatment of recurrent / metastatic nasopharyngeal carcinoma, the recommendation of grade III experts included pabolizumab, navulizumab, and domestic Hengrui self-developed karelizumab and Junshi's treprilimab, based on the clinical studies related to these four drugs. as we all know, the efficacy of single immunotherapy for nasopharyngeal carcinoma is not very good, and the objective response rate (ORR) is more than 20% to 30%. The combination of hengruicalizumab and chemotherapy has significantly improved the efficacy. this is because the immunogenicity of nasopharyngeal carcinoma is different from that of other head and neck tumors. Nasopharyngeal carcinoma is associated with Epstein Barr virus infection, and has higher immunogenicity and higher sensitivity to chemotherapy. Br / > at present, it is good to write the first-line treatment results after the first-line treatment. Prof. Zhang Chenping, executive director of the Department of oral and maxillofacial head and neck oncology, the Ninth People's Hospital Affiliated to Shanghai Jiaotong University, Professor II, School of medicine, Shanghai Jiaotong University, director of the training center of the Royal College of surgeons in Edinburgh and the International Association of oral and maxillofacial surgeons Shanghai's leading talents and top 10 doctors are committed to the surgery and functional reconstruction of oral and maxillofacial head and neck tumors. The leading scientific research achievement "technological innovation and popularization and application of jaw defect functional reconstruction" has won the second prize of national science and Technology Progress Award and the first prize of Shanghai Science and technology Progress Award. Q1: in recent years, the comprehensive treatment of MDT has been emphasized in CSCO head and neck tumor diagnosis and treatment guidelines How to treat the significance of MDT in the diagnosis and treatment of head and neck tumors? Prof. Zhang Chenping: the occurrence and development of tumors is a complex process. For head and neck tumors, especially oral cancer, the treatment is based on surgery. This concept has been inculcated since I was a medical student. For the medical students of maxillofacial and oral surgery in China, it is a very solid concept. the treatment of tumor not only depends on surgery, but also needs to be combined with radiotherapy and chemotherapy. These are the three magic weapons of tumor treatment, and one of them is indispensable. especially for patients with advanced head and neck tumors. the MDT advocated now includes the treatment and rehabilitation process of tumor. tumors that cannot be eradicated during surgery need to be controlled by radiotherapy. Postoperative adjuvant chemotherapy or immunotherapy in oncology department can prevent distant metastasis of tumor; postoperative patients need to improve their quality of life and carry out functional recovery training, which are all the contents of MDT. Q2: as an expert in oral and maxillofacial surgery, can you talk about the position of surgical treatment in the comprehensive treatment of MDT? In recent years, what are the major advances in surgical techniques in the treatment of head and neck tumors? Prof. Zhang Chenping: surgery is very important at present. I hope that after a period of development, surgery will become no status. if medical treatment can cure the disease, surgery will have no place. there are many diseases in history, including typhoid fever and malaria. These diseases could not be treated by medical means. For example, tuberculosis can only be removed directly. This is surgery. when the internal medicine technology is not mature, the surgical technology plays a very important role. After the internal medicine technology is mature, the status will be different. when it comes to the progress of surgical technology, I will consider: how many years can surgery last? I hope the shorter the time, the better. however, the reality is that surgery may be decades or even longer. surgery needs to be developed, and the development of new surgical technologies is uninterrupted. For example, the development of digital technology brings about the development of precision surgery; the development of repair and reconstruction technology brings about the development of functional surgery,Br / > I believe that there will be further expansion space in the future. For example, in locally advanced head and neck tumors, how to better combine immunotherapy with radiotherapy, chemotherapy and surgery is worth exploring. At present, there are some related clinical studies being carried out, expecting to obtain positive results, which can guide clinical practice in the future.