Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA.
J Oncol. 2012;2012:597467. doi: 10.1155/2012/597467. Epub 2012 May 30.
Intensity Modulated Radiotherapy (IMRT) is the standard of care in the treatment of head and neck squamous cell carcinomas (HNSCC) based on level 1 evidence. Technical advances in radiotherapy have revolutionized the treatment of HNSCC, with the most tangible gain being a reduction in long term morbidity. However, these benefits come with a serious and sobering price. Today, there is a greater chance of missing the target/tumor due to uncertainties in target volume definition by the clinician that is demanded by the highly conformal planning process involved with IMRT. Unless this is urgently addressed, our patients would be better served with the historically practiced non conformal radiotherapy, than IMRT which promises lesser morbidity. Image guided radiotherapy (IGRT) ensures the level of set up accuracy warranted to deliver a highly conformal treatment plan and should be utilized with IMRT, where feasible. Proton therapy has a theoretical physical advantage over photon therapy due to a lack of "exit dose". However, clinical data supporting the routine use of this technology for HNSCC are currently sparse. The purpose of this article is to review the literature, discuss the salient issues and make recommendations that address the gaps in knowledge.
调强放疗（IMRT）是基于 1 级证据的头颈部鳞状细胞癌（HNSCC）治疗的标准。放疗技术的进步彻底改变了 HNSCC 的治疗方式，最明显的好处是降低了长期发病率。然而，这些好处带来了一个严重而清醒的代价。如今，由于临床医生在定义靶区/肿瘤时存在不确定性，导致靶区漏照的可能性更大，而这正是 IMRT 高度适形计划所要求的。除非紧急解决这个问题，否则我们的患者接受历史上非适形放疗的效果可能会比 IMRT 更好，因为 IMRT 承诺的发病率更低。图像引导放疗（IGRT）可确保达到高度适形治疗计划所需的设置精度，并且应该与 IMRT 一起使用，如果可行的话。与光子治疗相比，质子治疗由于缺乏“出口剂量”而具有理论上的物理优势。然而，目前支持将这项技术常规用于 HNSCC 的临床数据还很匮乏。本文的目的是回顾文献，讨论突出问题，并提出建议，以填补知识空白。
