Ang K Kian
Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 0097, Houston, Texas 77030, USA.
Oncologist. 2008 Aug;13(8):899-910. doi: 10.1634/theoncologist.2007-0157. Epub 2008 Aug 13.
The management of locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) is highly complex. Data from recent clinical trials have altered the treatment landscape by refining the use of existing therapies, such as radiation therapy and chemotherapy, and providing new treatment options, such as cetuximab. Selecting the most appropriate treatment for an individual patient requires a multidisciplinary approach and careful assessment of the relative advantages and disadvantages of each treatment approach. Surgery is highly effective but can have debilitating long-term consequences. Chemoradiation and altered fractionation radiation therapy are more effective than conventional radiation therapy, but also more toxic; as a consequence of toxicity, suboptimal delivery of radiation may diminish, in practice, the efficacy observed in clinical trials of these strategies. Cetuximab plus radiation therapy is more effective than radiation alone and does not substantially increase radiation-related toxicity, or affect the delivery of planned radiotherapy. However, whether cetuximab plus radiation therapy is similar in efficacy to chemoradiation is unknown at this time. Ideally, multidisciplinary teams weigh all these factors when making individual treatment decisions. Data from current trials will help further optimize multimodality treatment for LA-SCCHN.
局部晚期头颈部鳞状细胞癌（LA-SCCHN）的管理非常复杂。近期临床试验的数据通过优化现有疗法（如放射治疗和化疗）的使用，并提供新的治疗选择（如西妥昔单抗），改变了治疗格局。为个体患者选择最合适的治疗方法需要多学科方法，并仔细评估每种治疗方法的相对优缺点。手术非常有效，但可能会产生使人衰弱的长期后果。放化疗和改变分割放疗比传统放疗更有效，但毒性也更大；由于毒性，在实际中，放疗的次优实施可能会降低这些策略在临床试验中观察到的疗效。西妥昔单抗联合放疗比单纯放疗更有效，且不会大幅增加放疗相关毒性，也不会影响计划放疗的实施。然而，目前尚不清楚西妥昔单抗联合放疗在疗效上是否与放化疗相似。理想情况下，多学科团队在做出个体治疗决策时会权衡所有这些因素。当前试验的数据将有助于进一步优化LA-SCCHN的多模态治疗。
