Wright Chadwick L, Pan Quintin, Knopp Michael V, Tweedle Michael F
Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210, USA.
World J Otorhinolaryngol Head Neck Surg. 2016 Jul 26;2(2):98-108. doi: 10.1016/j.wjorl.2016.05.006. eCollection 2016 Jun.
Worldwide, about 600,000 head and neck squamous cell carcinoma (HNSCC) are detected annually, many of which involve high risk human papilloma virus (HPV). Surgery is the primary and desired first treatment option. Following surgery, the existence of cancer cells at the surgical margin is strongly associated with eventual recurrence of cancer and a poor outcome. Despite improved surgical methods (robotics, microsurgery, endoscopic/laparoscopic, and external imaging), surgeons rely only on their vision and touch to locate tumors during surgery. Diagnostic imaging systems like computed tomography (CT), magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) and positron-emission tomography (PET) are too large, slow and costly to use efficiently during most surgeries and, ultrasound imaging, while fast and portable, is not cancer specific. This purpose of this article is to review the fundamental technologies that will radically advance Precision Otolaryngology practices to the benefit of patients with HNSCC. In particular, this article will address the potential for tumor-targeting peptides to enable more precise diagnostic imaging while simultaneously advancing new therapeutic paradigms for next generation image-guided surgery, tumor-specific chemotherapeutic delivery and tumor-selective targeted radiotherapy (i.e., theranostic).
在全球范围内，每年约有60万例头颈部鳞状细胞癌（HNSCC）被确诊，其中许多病例与高危型人乳头瘤病毒（HPV）有关。手术是主要且理想的首选治疗方案。手术后，手术切缘癌细胞的存在与癌症最终复发及不良预后密切相关。尽管手术方法有所改进（机器人手术、显微手术、内镜/腹腔镜手术以及外部成像技术），但外科医生在手术过程中仍仅依靠视觉和触觉来定位肿瘤。像计算机断层扫描（CT）、磁共振成像（MRI）、单光子发射计算机断层扫描（SPECT）和正电子发射断层扫描（PET）等诊断成像系统在大多数手术中使用起来太大、太慢且成本太高，而超声成像虽然快速且便于携带，但并非癌症特异性成像。本文的目的是回顾那些将从根本上推动精准耳鼻喉科实践发展，从而造福HNSCC患者的基础技术。特别是，本文将探讨肿瘤靶向肽在实现更精确诊断成像方面的潜力，同时推进下一代图像引导手术、肿瘤特异性化疗给药和肿瘤选择性靶向放疗（即治疗诊断）等新的治疗模式。
