Department of Radiation Oncology, Head and Neck Cancer Service, Peter MacCallum Cancer Centre, VIC, Australia.
Lancet Oncol. 2010 Mar;11(3):287-91. doi: 10.1016/S1470-2045(09)70384-5.
The intensity of contemporary treatment for locally advanced head and neck cancer is at the upper limit of human tolerance of acute toxicities. While impressive gains in locoregional control have been achieved, improvements in overall survival have been more modest. We hypothesise that unrecognised sequelae of highly toxic contemporary treatments substantially contribute to patient mortality. This possibility provides motivation to investigate reducing treatment intensity in selected patients with locally advanced head and neck cancer. With the demonstration of a good prognosis among subgroups of patients with head and neck cancer, major improvements in the technical delivery of radiotherapy, and further research into relevant factors in survivorship, we may be able to improve overall survival of patients with locally advanced disease without further increasing, and possibly reducing, treatment intensity.
当代针对局部晚期头颈部癌症的治疗强度已达到人类可耐受急性毒性的上限。虽然局部区域控制方面取得了显著的进展，但总体生存率的提高却较为有限。我们假设，高度毒性的当代治疗方法所带来的未被识别的后遗症，极大地促成了患者的死亡。这一可能性为我们提供了动力，促使我们对局部晚期头颈部癌症患者中选择适当的人群降低治疗强度进行研究。随着对头颈部癌症患者亚组中预后良好的证明、放疗技术的重大改进以及对生存相关因素的进一步研究，我们可能有希望在不进一步增加（甚至可能降低）治疗强度的情况下，提高局部晚期疾病患者的总体生存率。
