Visualization of Scattered Tumor Regression Following Neoadjuvant Chemoimmunotherapy With a Novel Intraoperative PET / CT Scanner

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Abstract
Background: Neoadjuvant chemoimmunotherapy is being explored in locally advanced head and neck squamous cell carcinoma (HNSCC), yet the spatial patterns of pathologic response and clinical implications remain poorly characterized. Methods: A 79‐year‐old female with recurrent left oral tongue SCC (PD‐L122C3 Combined Positive Score 90) who underwent prior resection and free flap reconstruction received neoadjuvant pembrolizumab, paclitaxel, and carboplatin followed by definitive surgical resection with intraoperative positron emission tomography/computed tomography (PET/CT) imaging. Results: Final histopathology revealed two discrete foci of residual poorly differentiated SCC, measuring 1.8 and 0.5 cm, separated by an 8 mm intervening bridge of inflammation without viable tumor. Intraoperative PET/CT with 3D specimen mapping confirmed the spatial relationship between residual foci and intervening treatment effect. Conclusions: Pathologic response to neoadjuvant chemoimmunotherapy in HNSCC can manifest as a multifocal regression pattern. Intraoperative real‐time approaches to assessing treatment response warrant further investigation. Trial Registration: ClinicalTrials.gov identifier: NCT06915454
Funding Information
  • National Cancer Institute (5K08CA293255‐02)

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