De-escalation Radiation Strategy After NAC in Combination With ICI in LAHNSCC

Inclusion criteria

• ≥18 years old, with medical decision-making capacity
• Signed informed consent
• ECOG score of 0-1
• Pathologically diagnosed with oral cancer, oropharyngeal cancer, laryngeal cancer, or hypopharyngeal cancer
• Exclusion of distant metastasis
• Clearly evaluable lesion (per RECIST 1.1 criteria)
• Expected life span ≥6 months
• Laboratory test results meet the following requirements: WBC ≥ 3×10^9/L, ANC ≥ 2.0×10^9/L, PLT ≥ 80×10^9/L, Hb ≥ 80g/L (according to the normal standards of the central laboratory); Liver function: Total bilirubin, ALT, and AST all ≤ 1.5x UNL (upper normal limit); AST (SGOT)/ALT (SGPT) ≤ 2.5 x IULN (upper normal limit); Kidney function: Cr ≤ 1.5x UNL (upper normal limit), and creatinine clearance rate ≥ 60 ml/min (calculated using the Cockcroft and Gault formula); Thyroid function T3 and T4 within the normal range (hypothyroidism can be corrected with oral thyroid hormone supplementation); Heart function: All three cardiac enzymes and pro-BNP within the normal range, no history of heart attack; Adrenal function: Normal cortisol secretion function or correctable based on endocrine assessment
• HBV-infected patients with HBV-DNA copy numbers less than 500 IU/ml
• No history of other malignant tumors in the past 5 years (excluding basal cell carcinoma of the skin and thyroid cancer).

Exclusion criteria

• No indications for curative radiotherapy or contraindications to radiochemotherapy.
• Clinical factors identified by the investigator that could potentially affect the completion of the study protocol (such as bleeding, active infection, or mental factors).
• Patients requiring long-term maintenance steroid therapy (including oral and intravenous use); local use or inhalation can be included in the study.
• Previous history of autoimmune diseases or in the active phase of the disease [including but not limited to inflammatory bowel disease (IBD), rheumatoid arthritis, autoimmune hepatitis, systemic sclerosis (scleroderma and its variants), systemic lupus erythematosus, autoimmune vasculitis, autoimmune neuropathies (such as Guillain-Barré syndrome)], vitiligo, and correctable endocrine deficiencies such as hypothyroidism and physiological cortisol deficiency can be included in the study and are not exclusion criteria.
• History of active tuberculosis or non-infectious pneumonia or any clinical evidence.
• Active phase of viral hepatitis, HBV DNA > 500 IU/ml.
• Acquired Immunodeficiency Syndrome (AIDS).
• Concurrent severe medical conditions (including heart diseases) with coexisting diseases or conditions affecting the patient's normal enrollment or safety during the study.
• Prior immunotherapy for other tumors.
• History of other malignant tumors within 5 years (excluding cured basal cell carcinoma of the skin or thyroid cancer).
• Pregnant or lactating women.
• Concurrently suffering from other malignant tumors.
• Cannot or unwilling to sign the informed consent form.
• Vaccination within 4 weeks.
• Allergic reaction to the investigational drug.