Pryor David I, Solomon Benjamin, Porceddu Sandro V
Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia.
Asia Pac J Clin Oncol. 2011 Sep;7(3):236-51. doi: 10.1111/j.1743-7563.2011.01420.x.
Over the past three decades there has been a move toward organ preservation protocols in the management of locally advanced mucosal head and neck squamous cell carcinomas (LAHNSCC) with combinations of radiotherapy (RT), chemotherapy and, more recently, biological agents. Current standard chemoradiation strategies have reached the upper limits of toxicity. In addition, the traditional one size fits all approach of grouping patients according to traditional clinicopathological features fails to take into account the vast underlying biological heterogeneity of tumors and their host. A number of recent advances such as highly conformal RT, molecular profiling and targeted agents, and improvements in treatment response assessment have set the scene for a fundamental paradigm shift toward greater tailoring of therapy with the aim of improving outcomes and reducing the burden of survivorship. This review focuses on the recognition of the prognostic value of tumor human papillomavirus (HPV) status, the incorporation of biologically targeted therapies and the evolving role of molecular imaging in predicting tumor response and prognosis in the curative management of LAHNSCC.
在过去三十年中，对于局部晚期黏膜头颈部鳞状细胞癌（LAHNSCC）的治疗，已逐渐转向采用放疗（RT）、化疗以及最近的生物制剂联合的器官保存方案。当前的标准放化疗策略已达到毒性上限。此外，传统的根据传统临床病理特征对患者进行一刀切分组的方法，未能考虑到肿瘤及其宿主潜在的巨大生物学异质性。诸如高剂量适形放疗、分子谱分析和靶向药物等多项最新进展，以及治疗反应评估的改进，为朝着更精准定制治疗方案的根本性范式转变奠定了基础，旨在改善治疗效果并减轻生存负担。本综述重点关注肿瘤人乳头瘤病毒（HPV）状态的预后价值的认识、生物靶向治疗的纳入以及分子成像在预测LAHNSCC根治性治疗中的肿瘤反应和预后方面不断演变的作用。
