Caudell Jimmy J, Torres-Roca Javier F, Gillies Robert J, Enderling Heiko, Kim Sungjune, Rishi Anupam, Moros Eduardo G, Harrison Louis B
Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Department of Cancer Imaging and Metabolism, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Lancet Oncol. 2017 May;18(5):e266-e273. doi: 10.1016/S1470-2045(17)30252-8. Epub 2017 Apr 26.
Radiotherapy has long been the mainstay of treatment for patients with head and neck cancer and has traditionally involved a stage-dependent strategy whereby all patients with the same TNM stage receive the same therapy. We believe there is a substantial opportunity to improve radiotherapy delivery beyond just technological and anatomical precision. In this Series paper, we explore several new ideas that could improve understanding of the phenotypic and genotypic differences that exist between patients and their tumours. We discuss how exploiting these differences and taking advantage of precision medicine tools-such as genomics, radiomics, and mathematical modelling-could open new doors to personalised radiotherapy adaptation and treatment. We propose a new treatment shift that moves away from an era of empirical dosing and fractionation to an era focused on the development of evidence to guide personalisation and biological adaptation of radiotherapy. We believe these approaches offer the potential to improve outcomes and reduce toxicity.
放射治疗长期以来一直是头颈癌患者的主要治疗手段，传统上采用分阶段治疗策略，即所有处于相同TNM分期的患者接受相同的治疗。我们认为，除了提高技术和解剖学精度之外，还有很大的机会改进放射治疗的实施。在本系列论文中，我们探讨了几个新观点，这些观点有助于增进对患者及其肿瘤之间存在的表型和基因型差异的理解。我们讨论了如何利用这些差异，并借助基因组学、放射组学和数学建模等精准医学工具，为个性化放疗调整和治疗打开新的大门。我们提出了一种新的治疗转变，即从经验性剂量和分割时代转向专注于发展证据以指导放疗个性化和生物学适应性的时代。我们相信这些方法有潜力改善治疗效果并降低毒性。
