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From Radical Resection to Precision Surgery: Integrating Diagnostic Biomarkers, Radiomics-Based Predictive Models,
Luiz P Kowalski1, Carol R Bradford2, Jonathan J Beitler3
1Head and Neck Surgery Department and LIM 28, University of São Paulo Medical School and A C Camargo Cancer Center, São Paulo 05403-000, Brazil.
Abstract:
Head and neck cancer surgery has evolved from radical organ-sacrificing procedures to function-preserving approaches integrated within multidisciplinary frameworks. This comprehensive literature review, concentrating on studies from the past five years while incorporating relevant publications from the last three decades and landmark historical papers, examines the evolving role of surgery emphasizing diagnostic methodologies including comprehensive genomic profiling, validated imaging biomarkers, and their clinical integration for treatment selection and response prediction. Modern surgical practice demonstrates a paradigm shift toward precision medicine through validated diagnostic technologies. Comprehensive genomic profiling identifies clinically actionable alterations in over 90% of head and neck squamous cell carcinomas, with tumor mutational burden serving as a validated predictive biomarker for immunotherapy response. Programmed death-ligand 1 (PD-L1) combined positive score functions as a validated diagnostic biomarker for immunotherapy efficacy, demonstrating significant clinical benefit in biomarker-selected populations. Radiomics-based predictive models utilizing machine learning algorithms achieve diagnostic accuracies exceeding 85% for treatment response prediction when validated across independent cohorts. Quantitative ultrasound spectroscopy combined with magnetic resonance imaging radiomics demonstrates high sensitivity and specificity for radiation response prediction. Habitat imaging techniques characterizing tumor microenvironmental heterogeneity predict pathologic complete response to neoadjuvant chemoimmunotherapy with area under the curve values approaching 0.90 in validation studies. Integration of these diagnostic methodologies enables response-adaptive treatment strategies, with neoadjuvant chemotherapy facilitating mandibular preservation and adjuvant therapy omission in over half of human papillomavirus (HPV)-associated cases following surgical downstaging. Clinical validation of these diagnostic platforms enables accurate treatment response prediction and informed surgical decision-making, though standardization across institutions and demonstration of survival benefits through prospective trials remain essential for broader implementation.
Insights
Modern head and neck cancer surgery uses precision diagnostics like genomic profiling and imaging biomarkers for tailored treatment. These tools predict immunotherapy response and treatment outcomes, enabling function-preserving approaches.
Area of Science:
- Oncology
- Surgical Oncology
- Genomics
Background:
- Head and neck cancer surgery has shifted from radical procedures to function-preserving methods.
- Multidisciplinary care frameworks now integrate advanced diagnostic technologies.
Purpose of the Study:
- To review the evolving role of surgery in head and neck cancer.
- To examine diagnostic methodologies for treatment selection and response prediction.
- To highlight the integration of genomic profiling and imaging biomarkers.
Main Methods:
- Comprehensive literature review of studies from the past five years, with inclusion of historical and recent publications.
- Analysis of diagnostic technologies including comprehensive genomic profiling, imaging biomarkers (radiomics, quantitative ultrasound, habitat imaging), and machine learning algorithms.
Main Results:
- Comprehensive genomic profiling identifies actionable alterations in >90% of head and neck squamous cell carcinomas.
- Tumor mutational burden and PD-L1 scores are validated predictive biomarkers for immunotherapy.
- Radiomics and habitat imaging models show high accuracy (>85%) in predicting treatment response and radiation sensitivity.
- Integration of diagnostics enables adaptive strategies, reducing adjuvant therapy in HPV-associated cancers.
Conclusions:
- Validated diagnostic platforms facilitate precise treatment selection and response prediction in head and neck cancer surgery.
- Precision medicine approaches are transforming surgical practice towards function preservation.
- Further standardization and prospective trials are needed to demonstrate survival benefits and ensure broader implementation.
