Krstevska V
Department of Head and Neck Cancer, University Clinic of Radiotherapy and Oncology, Skopje, FYROM.
J BUON. 2009 Jul-Sep;14(3):361-73.
Throughout the past two decades the efforts to improve the efficacy of treatment for locally advanced head and neck squamous cell carcinoma (HNSCC) have led to increased use of multimodality approaches combining surgery, radiotherapy (RT), and chemotherapy (CT). Conventional RT, a standard approach for locoregionally advanced disease, was associated with unsatisfactory results, thereby, a greater understanding of radiobiology led to the development of two classes of altered radiation fractionation schedules incorporating hyperfractionation (HF) and acceleration in the management of advanced HNSCC. Randomized controlled trials and meta-analyses demonstrated that for patients with locally advanced HNSCC major improvements in locoregional control (LRC) at high level of evidence can be achieved by accelerated fractionation (AF) and HF. For these patients, overall survival (OS) may be improved at high level of evidence by HF delivered with increased total dose. CT represents an important component of multimodality treatment approach for locally advanced HNSCC with concurrent addition of CT to RT being the most significant method for improving head and neck cancer (HNC) outcome. Several randomized studies and meta-analyses on the administration of concurrent chemoradiotherapy (CCRT) demonstrated clear evidence that CCRT provides a substantial and statistically significant improvement in survival and locoregional control, as compared to RT alone. CCRT is now a standard treatment approach for patients with locally advanced HNSCC. CCRT has been also shown to allow organ preservation in almost two thirds of patients without affecting survival. Recently, strong evidence for an improved outcome for high-risk resected patients has been shown by the use of adjuvant CCRT.
在过去二十年中，为提高局部晚期头颈部鳞状细胞癌（HNSCC）的治疗效果所做的努力，促使人们更多地采用手术、放疗（RT）和化疗（CT）相结合的多模式治疗方法。传统放疗作为局部区域晚期疾病的标准治疗方法，效果并不理想，因此，对放射生物学的深入了解促使人们开发了两类改变放疗分割方案，即超分割放疗（HF）和加速放疗，用于晚期HNSCC的治疗。随机对照试验和荟萃分析表明，对于局部晚期HNSCC患者，加速分割放疗（AF）和HF可在高证据水平上显著改善局部区域控制（LRC）。对于这些患者，通过增加总剂量进行HF放疗，可在高证据水平上改善总生存期（OS）。CT是局部晚期HNSCC多模式治疗方法的重要组成部分，同步将CT与RT联合使用是改善头颈癌（HNC）治疗效果的最重要方法。多项关于同步放化疗（CCRT）的随机研究和荟萃分析表明，与单纯放疗相比，CCRT在生存和局部区域控制方面有显著的统计学改善。CCRT现在是局部晚期HNSCC患者的标准治疗方法。CCRT还被证明可使近三分之二的患者实现器官保留，且不影响生存。最近，辅助CCRT的应用已显示出高危切除患者预后改善的有力证据。
