Photoimmunotherapy for Recurrent or Unresectable Head and Neck Cancer: Clinical Outcomes and Perioperative Airway Management.

OBJECTIVE: This study aimed to evaluate the clinical outcomes of photoimmunotherapy (PIT) for recurrent or unresectable head and neck cancer, explore characteristics associated with treatment response, and assess perioperative airway management. METHODS: This retrospective study included 11 consecutive patients undergoing PIT at a single institution between February 2023 and October 2025. Patients were classified by best overall response; clinical characteristics, prior treatments, and perioperative airway management were analysed. RESULTS: Six patients (55%) achieved a complete response, whereas five experienced progressive disease. Six-month overall and progression-free survival rates were 81.8% and 72.7%, respectively; median progression-free survival was 10.3 months, and median overall survival was not reached. Complete responders predominantly presented with oral or sinonasal tumours and received PIT earlier with fewer prior treatments, whereas non-responders were heavily pretreated with chemotherapy, radiotherapy, and immune checkpoint inhibitors. A stepwise airway strategy involved reassessing laryngeal findings on postoperative day 1 (POD1), followed by extubation, continued observation until POD2, or tracheostomy if required. This approach ensured safe management, although one patient developed transient intensive care unit (ICU)-acquired weakness following prolonged intubation. CONCLUSIONS: PIT introduction in carefully selected patients-including those with metachronous second primary tumours or minimal residual disease following chemoradiotherapy-may improve local control. A stepwise, protocol-based airway management approach, incorporating reassessment on POD1 and POD2, ensures safety whilst minimising intubation-related complications.