Wirth Lori J, Burtness Barbara, Nathan Cherie-Ann O, Grégoire Vincent, Richmon Jeremy
1 From the Massachusetts General Hospital Cancer Center, Harvard University, and Harvard Medical School, Boston, MA.
2 Yale University School of Medicine, New Haven, CT.
Am Soc Clin Oncol Educ Book. 2019 Jan;39:364-372. doi: 10.1200/EDBK_238315. Epub 2019 May 17.
HPV-positive (HPV+) oropharyngeal carcinoma (OPC) continues to increase in incidence across the globe. Multimodality treatment offers a high likelihood of cure in HPV+ OPC but comes at a high cost of treatment-related morbidity. As a result, de-escalation of treatment to limit toxicity without compromising high cure rates has emerged as a major trend in head and neck cancer clinical research. Primary surgery with minimally invasive resection of the primary disease may allow for the elimination of chemotherapy and decrease radiation dose intensity. Primary dose-reduced radiation, with or without systemic therapy, is also under study, as is replacing concurrent cisplatin with newer systemic agents. Numerous institutional series and phase II trials have been presented, and the first generation of de-escalation randomized phase III trials have now been published. The various combinatorial multimodality strategies to achieve less intensive and toxic therapy are many. Has the time come for de-escalation as a standard approach to HPV+ OPC? The pros and cons, as well as the best approaches for de-escalated treatment of HPV+ OPC, are debated here.
人乳头瘤病毒阳性（HPV+）口咽癌（OPC）在全球的发病率持续上升。多模式治疗使HPV+ OPC有很高的治愈可能性，但治疗相关的发病率成本高昂。因此，在不影响高治愈率的情况下降低治疗强度以限制毒性，已成为头颈癌临床研究的一个主要趋势。对原发性疾病进行微创切除的原发性手术可能无需化疗并降低放射剂量强度。减少原发性放射剂量，无论是否进行全身治疗，也在研究中，用更新的全身药物取代顺铂同步治疗也是如此。已经公布了许多机构系列研究和II期试验，第一代降低治疗强度的随机III期试验现已发表。实现强度和毒性较低治疗的各种联合多模式策略众多。降低治疗强度作为HPV+ OPC的标准方法的时机到了吗？本文将对HPV+ OPC降低治疗强度的利弊以及最佳方法进行讨论。
