Department of Radiation Oncology, National University Cancer Institute Singapore, National University Health System and National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 7, 119228, Singapore.
Expert Rev Anticancer Ther. 2010 Sep;10(9):1439-50. doi: 10.1586/era.10.97.
Nasopharyngeal carcinoma is uncommon worldwide, but poses a significant public health burden in endemic regions. Primary treatment for nonmetastatic disease is by radiation therapy, which has evolved from simple 2D-planning techniques to intensity-modulated radiation therapy. The role of systemic therapy has also become more prominent, with concurrent cisplatin-based chemoradiation the current standard of care for locally advanced disease based on multiple Phase III studies. Based on these advances, the prognosis of nasopharyngeal carcinoma appears to have improved significantly over the past two decades. Nevertheless, there are areas of substantial uncertainty and divergent views in the optimal treatment strategy. Distant metastases have become the dominant mode of treatment failure with the excellent local control provided by intensity-modulated radiation therapy. Recent studies have focused on this challenge of treating micrometastases while keeping toxicities manageable. Radiation therapy techniques continue to be refined to maintain consistently high locoregional tumor control while decreasing the probability of acute and late toxicities. This article discusses some of the current issues confronting the multidisciplinary team managing this disease.
鼻咽癌在世界范围内并不常见，但在流行地区对公众健康造成了重大负担。非转移性疾病的主要治疗方法是放射治疗，放射治疗已经从简单的二维规划技术发展到强度调制放射治疗。系统治疗的作用也变得更加突出，基于多项 III 期研究，顺铂为基础的同期放化疗已成为局部晚期疾病的标准治疗方法。基于这些进展，过去二十年来，鼻咽癌的预后似乎有了显著改善。然而，在最佳治疗策略方面，仍存在大量不确定因素和不同观点。由于强度调制放射治疗提供了极好的局部控制，远处转移已成为治疗失败的主要模式。最近的研究集中在治疗微转移的同时保持毒性可管理的挑战上。放射治疗技术继续得到改进，以保持一致的高局部肿瘤控制，同时降低急性和迟发性毒性的概率。本文讨论了管理这种疾病的多学科团队目前面临的一些问题。
