Approximately two-thirds of patients with head and neck squamous cell carcinoma present with locally advanced disease at the time of consultation.Even with the multidisciplinary team(MDT)diagnosis and treatment model,their treatment outcomes still need improvement.Immunotherapy has become the standard treatment for recurrent and metastatic head and neck squamous cell carcinoma.In recent years,it has achieved initial success in clinical studies on locally advanced diseases,especially in the perioperative period,but its application in other treatment fields still faces many problems.The Head and Neck Cancer Committee of Chinese Society of Clinical Oncology organized experts to form 14 consensus opinions through multiple rounds of discussions informed by evidence-based medical evidence and clinical practice.Thess consensus statements were finally formulated,comprehensively covering the entire management of immunotherapy for locally advanced head and neck squamous cell carcinoma,summarized as follows:① Regarding the whole-course treatment strategy,for patients with locally advanced head and neck squamous cell carcinoma undergoing radical surgery followed by adjuvant chemoradiotherapy,a comprehensive treatment approach combining neoadjuvant immunotherapy,immunotherapy combined with chemoradiotherapy,and adjuvant immunotherapy is recommended.② In the neoadjuvant treatment phase,for patients requiring neoadjuvant immunotherapy,the combination of immunotherapy with chemotherapy is recommended,with a course of 2-3 cycles.For non-oral cancer patients who achieve radiological tumor response after neoadjuvant treatment and require organ preservation,definitive radiotherapy should be administered.③ The immunotherapy combined with radiotherapy phase remains controversial,and the optimal treatment regimen and patient selection criteria require further clinical investigation.④ In the adjuvant immunotherapy phase,for locally advanced head and neck squamous cell carcinoma patients with high-risk factors,the combination of adjuvant radiotherapy with immunotherapy is recommended postoperatively,with a course of adjuvant immunotherapy ranging from 6 to 12 months.Corresponding recommendation levels for different treatment scenarios are obtained through voting.This consensus will help guide the standardized application of immunotherapy for locally advanced head and neck squamous cell carcinoma,lay the foundation for further clinical research,and strive to promote the research level of immunotherapy for locally advanced head and neck squamous cell carcinoma in China.This consensus has been registered on the Practice guideline REgistration for transPAREncy(PREPARE)platform,with the registration number PREPARE-2025CN1241.

The concept of competency-based standardized residency training is gaining global popularity. However, the process of assessing, continuously evaluating, and conducting final competency evaluations remains challenging. The Milestones 2.0 system, developed by the Accreditation Council for Graduate Medical Education, provides a framework for evaluating competencies in radiation oncology residents. The core objective of this system is to assess sub-competencies within core competencies, categorizing them from novice to expert across 5 levels. Evaluation occurs every 6 months, with the expectation that all residents reach level 4 in all sub-competencies by the end of their training. This approach aims to enhance the standardization of residency evaluations across the United States. This article aims to analyze the Milestones 2.0 competency framework and explore its potential applicability and reference value for standardized radiation oncology residency training in China.

Head and neck squamous cell carcinoma(HNSCC)is the most common type of head and neck cancer,and its treatment prognosis remains suboptimal.Although the survival of HNSCC patients has improved with the widespread use of anti-epidermal growth factor receptor(EGFR)monoclonal antibodies and immune checkpoint inhibitors(ICIs),there is still significant room for further improvement.Recent studies have suggested that the combination of anti-EGFR monoclonal antibodies and ICIs offers promising efficacy and safety,earning recommendations from authoritative guidelines such as the National Comprehensive Cancer Network(NCCN)and the Chinese Society of Clinical Oncology(CSCO).However,the application of this combination therapy is still in the early exploratory stage,numerous questions regarding the standardized clinical use of this combination therapy remain unanswered,including the mechanisms of synergy associated with the combination treatment,its therapeutic value in different patient populations,and safety considerations.Committee of Head and Neck Cancer,Chinese Society of Clinical Oncology organized an expert panel to develop"Expert consensus on the combination of anti-EGFR monoclonal antibodies and immune checkpoint inhibitors in the treatment of head and neck squamous cell carcinoma(2025 edition)",based on evidence-based medicine and clinical practice exploration through multiple rounds of discussions.This consensus addressed the mechanisms of the combination of anti-EGFR monoclonal antibodies and ICIs,stratified treatment approaches,applications in special populations,and safety considerations.The consensus has been registered on Practice guideline REgistration for transPAREncy(PREPARE)with the registration number PREPARE-2025CN666.It is hoped that this consensus will provide clearer and more practical guidance for clinicians,further promoting the rational application of this combination therapy in clinical practice and offering more treatment options for HNSCC patients.

Radiochemotherapy-induced oral mucositis (OM) is a common oral complication in patients with tumors following head and neck radiotherapy or chemotherapy. Erosion and ulcers are the main features of OM that seriously affect the quality of life of patients and even the progress of tumor treatment. To date, differences in clinical prevention and treatment plans for OM have been noted among doctors of various specialties, which has increased the uncertainty of treatment effects. On the basis of current research evidence, this expert consensus outlines risk factors, clinical manifestations, clinical grading, ancillary examinations, diagnostic basis, prevention and treatment strategies and efficacy indicators for OM. In addition to strategies such as basic oral care, anti-inflammatory and analgesic agents, anti-infective agents, pro-healing agents, and photobiotherapy recommended in previous guidelines, we also emphasize the role of traditional Chinese medicine in OM prevention and treatment. This expert consensus aims to provide references and guidance for dental physicians and oncologists in formulating strategies for OM prevention, diagnosis, and treatment, standardizing clinical practice, reducing OM occurrence, promoting healing, and improving the quality of life of patients.
Humans ; Chemoradiotherapy/adverse effects* ; Consensus ; Risk Factors ; Stomatitis/etiology*

Head and neck squamous cell carcinoma(HNSCC)is the most common type of head and neck cancer,and its treatment prognosis remains suboptimal.Although the survival of HNSCC patients has improved with the widespread use of anti-epidermal growth factor receptor(EGFR)monoclonal antibodies and immune checkpoint inhibitors(ICIs),there is still significant room for further improvement.Recent studies have suggested that the combination of anti-EGFR monoclonal antibodies and ICIs offers promising efficacy and safety,earning recommendations from authoritative guidelines such as the National Comprehensive Cancer Network(NCCN)and the Chinese Society of Clinical Oncology(CSCO).However,the application of this combination therapy is still in the early exploratory stage,numerous questions regarding the standardized clinical use of this combination therapy remain unanswered,including the mechanisms of synergy associated with the combination treatment,its therapeutic value in different patient populations,and safety considerations.Committee of Head and Neck Cancer,Chinese Society of Clinical Oncology organized an expert panel to develop"Expert consensus on the combination of anti-EGFR monoclonal antibodies and immune checkpoint inhibitors in the treatment of head and neck squamous cell carcinoma(2025 edition)",based on evidence-based medicine and clinical practice exploration through multiple rounds of discussions.This consensus addressed the mechanisms of the combination of anti-EGFR monoclonal antibodies and ICIs,stratified treatment approaches,applications in special populations,and safety considerations.The consensus has been registered on Practice guideline REgistration for transPAREncy(PREPARE)with the registration number PREPARE-2025CN666.It is hoped that this consensus will provide clearer and more practical guidance for clinicians,further promoting the rational application of this combination therapy in clinical practice and offering more treatment options for HNSCC patients.

Approximately two-thirds of patients with head and neck squamous cell carcinoma present with locally advanced disease at the time of consultation.Even with the multidisciplinary team(MDT)diagnosis and treatment model,their treatment outcomes still need improvement.Immunotherapy has become the standard treatment for recurrent and metastatic head and neck squamous cell carcinoma.In recent years,it has achieved initial success in clinical studies on locally advanced diseases,especially in the perioperative period,but its application in other treatment fields still faces many problems.The Head and Neck Cancer Committee of Chinese Society of Clinical Oncology organized experts to form 14 consensus opinions through multiple rounds of discussions informed by evidence-based medical evidence and clinical practice.Thess consensus statements were finally formulated,comprehensively covering the entire management of immunotherapy for locally advanced head and neck squamous cell carcinoma,summarized as follows:① Regarding the whole-course treatment strategy,for patients with locally advanced head and neck squamous cell carcinoma undergoing radical surgery followed by adjuvant chemoradiotherapy,a comprehensive treatment approach combining neoadjuvant immunotherapy,immunotherapy combined with chemoradiotherapy,and adjuvant immunotherapy is recommended.② In the neoadjuvant treatment phase,for patients requiring neoadjuvant immunotherapy,the combination of immunotherapy with chemotherapy is recommended,with a course of 2-3 cycles.For non-oral cancer patients who achieve radiological tumor response after neoadjuvant treatment and require organ preservation,definitive radiotherapy should be administered.③ The immunotherapy combined with radiotherapy phase remains controversial,and the optimal treatment regimen and patient selection criteria require further clinical investigation.④ In the adjuvant immunotherapy phase,for locally advanced head and neck squamous cell carcinoma patients with high-risk factors,the combination of adjuvant radiotherapy with immunotherapy is recommended postoperatively,with a course of adjuvant immunotherapy ranging from 6 to 12 months.Corresponding recommendation levels for different treatment scenarios are obtained through voting.This consensus will help guide the standardized application of immunotherapy for locally advanced head and neck squamous cell carcinoma,lay the foundation for further clinical research,and strive to promote the research level of immunotherapy for locally advanced head and neck squamous cell carcinoma in China.This consensus has been registered on the Practice guideline REgistration for transPAREncy(PREPARE)platform,with the registration number PREPARE-2025CN1241.

The concept of competency-based standardized residency training is gaining global popularity. However, the process of assessing, continuously evaluating, and conducting final competency evaluations remains challenging. The Milestones 2.0 system, developed by the Accreditation Council for Graduate Medical Education, provides a framework for evaluating competencies in radiation oncology residents. The core objective of this system is to assess sub-competencies within core competencies, categorizing them from novice to expert across 5 levels. Evaluation occurs every 6 months, with the expectation that all residents reach level 4 in all sub-competencies by the end of their training. This approach aims to enhance the standardization of residency evaluations across the United States. This article aims to analyze the Milestones 2.0 competency framework and explore its potential applicability and reference value for standardized radiation oncology residency training in China.

Objective:To evaluate the short-term tumor control and toxicity of recurrent skull base and cervical spine chordoma and chondrosarcoma in patients treated with pencil beam scanning proton and heavy ion therapy.Methods:Between June 30 th, 2014 and July 30 th, 2018, a total of 45 skull base and cervical spine chordoma ( n=39) and chondrosarcoma ( n=6) patients (28 males and 17 females; mean age at initial presentation of 44 years, range, 14-76 years) were treated in our center for the course of radiotherapy. The median maximum tumor volume was 57 cm 3 (range, 6.6-231.7 cm 3). There were 31 post-operative recurrent patients and 14 post-operative and post-radiated recurrent patients. One patient received proton therapy, 21 patients received combined proton and carbon ion therapy, 23 patients received carbon ion therapy. Results:All patients completed the whole course of the treatment. The median follow-up time was 29 months (range: 8-57 months), the 2-year overall survival (OS), local control (LC), and progression-free survival (PFS) were 82.7%, 85.3%, and 73.8%, respectively. There were no other grade 3-4 acute or late radiation-induced toxicity except one grade 3 acute mucositis. The 2-year OS rates for patients after first-time radiation vs. re-irradiation were 96.2% and 50.3% ( χ2=16.969, P<0.05). Conclusions:The short-term outcomes of pencil beam scanning proton and heavy ion therapy for recurrent skull base and cervical spine chordoma and chondrosarcoma is favorable. Further study is needed for long-term efficacy and safety.

Objective:To evaluate the diagnostic value of HPV detection in squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site.Methods:Clinical data of 6 patients who were initially diagnosed with squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site and eventually diagnosed with HPV-related oropharyngeal squamous cell carcinoma were collected, and the process of diagnosis was analyzed.Results:Upon the initial admission, all patients were diagnosed with squamous cell carcinoma of the cervical lymph node metastasis with positive p16 expression, positive HPV-16 subtype and negative EBER expression. No obvious primary lesion was found after comprehensive examination. Subsequently, four of them underwent ipsilateral tonsollar blind biopsy ( n=2) and ipsilateral tonsillectomy ( n=2). All these four patients were pathologically diagnosed with tonsillar squamous cell carcinoma. For the other two cases, MRI detected the thickening complicated with enhancement of ipsilateral wall of oropharynx and tongue root after follow-up for D149 and D545 , respectively. Biopsy confirmed the diagnosis of squamous cell carcinoma of the tonsil and tongue root, respectively. Conclusion:For patients with HPV-positive squamous cell carcinoma of the cervical lymph node metastasis from an unknown primary site, the possibility that the primary lesion originates from the oropharyngeal site, especially the tonsil and tongue root, should be highly suspected.

Radiation-induced dermatitis (RD) is one of the most common complications induced by radiotherapy in cancer patients.The incidence and severity of RD are largely associated with the risk factors of patients.RD can severely affect the quality of life,even discontinue the treatment and reduce the tumor control rate in severe patients.Currently,randomized control trials evaluating the preventive measures for acute RD have been rarely conducted.The clinical interventions for acute RD significantly vary.In this article,the pathogenesis,risk factors,clinical manifestations,evaluation,prevention and treatment of RD were investigated.