Causes of immunosuppression in squamous cell carcinoma of the head and neck

Numerous dysfunctions of the immune system with prognostic relevance can be found in patients with SCCHN. The role of the different factors affecting the immune system has to be investigated in the future with particular consideration being given to the specific therapy indicated. Varying therapies modifying the immune system are available. It is necessary to clarify whether and how SCCHN patients can benefit from these forms of treatment and how dysfunctions of the immune system can be corrected without causing excessive reactions. From a surgical point of view one has to consider whether immune stimulation or reconstructive measures are indicated in patients with decreased immunity and whether less traumatic procedures with smaller blood loss may have a beneficial effect on the tumor's immunological situation, and therefore on the overall survival of the patient. The terms minimal-invasive or functional surgery may take on a new meaning as biologically-adjusted surgery, biologic preservative reconstructive surgery or biologically functional surgery. In SCCHN not only the radical removal of the primary tumor is of concern, but also the regional lymph nodes and their importance for other lymph nodes, the primary tumor and the immunity of the patient as a whole. These factors have to be taken into consideration in the therapeutic planning for the patient. Therapeutic efforts in SCCHN patients should therefore not only aim at the functional preservation of organs and at plastic reconstructive procedures but also preserve and, by biological immunotherapy, restore the tumor-specific immunity. This may result in better survival rates with better quality of life, even in complicated cases.