Al-Mamgani A, Verheij M, van den Brekel M W M
Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Eur J Cancer. 2017 Sep;82:1-5. doi: 10.1016/j.ejca.2017.05.035. Epub 2017 Jun 19.
There is a long-standing convention to irradiate the great majority of head and neck squamous cell carcinoma (HNSCC) electively to both sides of the neck, to reduce the theoretically increased risk of contralateral regional failure (cRF). With the currently available diagnostic imaging techniques this treatment paradigm means, in our opinion, an overtreatment in considerable proportion of these patients. From all the published studies (n = 11, with 1116 patients treated in total), the incidence of cRF in patients with oropharyngeal cancer treated to one side of the neck is 2.4%. The incidence was higher in patients with tumours involving the midline (12.1%). The low incidence of cRF was also seen in patients with HNSCC treated by local excision combined with unilateral neck dissection or sentinel node procedure. It seems clear from the aggregated data of these studies that a less conservative approach with regard to the selection of patients for unilateral elective nodal irradiation is justified. The fear of leaving the contralateral neck untreated in well-selected groups of patients with HNSCC needs nowadays to be mitigated since the incidence of cRF in lateralised tumours extending to but not crossing the midline is low. Furthermore, the obviously improved diagnostic imaging nowadays could help us to guide the selection of considerable proportion of patients with lateralised HNSCC for unilateral elective nodal irradiation with significant reduction of radiation-related toxicity and improved quality of life.
长期以来的惯例是，对绝大多数头颈部鳞状细胞癌（HNSCC）患者进行双侧颈部选择性放疗，以降低理论上对侧区域复发（cRF）风险增加的情况。我们认为，按照目前可用的诊断成像技术，这种治疗模式意味着在相当一部分此类患者中存在过度治疗。在所有已发表的研究中（n = 11，共治疗1116例患者），接受单侧颈部放疗的口咽癌患者中cRF的发生率为2.4%。肿瘤累及中线的患者发生率更高（12.1%）。在接受局部切除联合单侧颈部清扫术或前哨淋巴结手术治疗的HNSCC患者中也观察到cRF发生率较低。从这些研究的汇总数据来看，对于选择单侧选择性淋巴结照射的患者采取不那么保守的方法似乎是合理的。如今，对于精心挑选的HNSCC患者群体，不必再担心不对侧颈部进行治疗，因为向中线延伸但未越过中线的侧方肿瘤的cRF发生率较低。此外，如今明显改进的诊断成像技术可以帮助我们指导相当一部分侧方HNSCC患者选择单侧选择性淋巴结照射，从而显著降低与放疗相关的毒性并改善生活质量。
