Mirghani H, Amen F, Blanchard P, Moreau F, Guigay J, Hartl D M, Lacau St Guily J
Department of Head and Neck surgery, Institut de Cancérologie Gustave Roussy, Villejuif, France.
Int J Cancer. 2015 Apr 1;136(7):1494-503. doi: 10.1002/ijc.28847. Epub 2014 Apr 4.
Due to the generally poor prognosis of head and neck squamous cell carcinoma (HNSCC), treatment has been intensified, these last decades, leading to an increase of serious side effects. High-risk human papillomavirus (HR-HPV) infection has been recently etiologically linked to a subset of oropharyngeal squamous cell carcinoma (OPSCC), which is on the increase. These tumors are different, at the clinical and molecular level, when compared to tumors caused by traditional risk factors. Additionally, their prognosis is much more favorable which has led the medical community to consider new treatment strategies. Indeed, it is possible that less intensive treatment regimens could achieve similar efficacy with less toxicity and improved quality of life. Several clinical trials, investigating different ways to de-escalate treatment, are currently ongoing. In this article, we review these main approaches, discuss the rationale behind them and the issues raised by treatment de-escalation in HPV-positive OPSCC.
由于头颈部鳞状细胞癌（HNSCC）的总体预后通常较差，在过去几十年中治疗强度不断加大，导致严重副作用增加。高危型人乳头瘤病毒（HR-HPV）感染最近在病因学上与口咽鳞状细胞癌（OPSCC）的一个亚组相关，且该亚组病例正在增加。与由传统风险因素引起的肿瘤相比，这些肿瘤在临床和分子水平上有所不同。此外，它们的预后要好得多，这促使医学界考虑新的治疗策略。事实上，强度较低的治疗方案有可能在毒性更小、生活质量更高的情况下达到相似的疗效。目前正在进行几项临床试验，研究不同的治疗降级方法。在本文中，我们回顾这些主要方法，讨论其背后的原理以及HPV阳性OPSCC治疗降级所引发的问题。
