Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, P R China.
Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, P R China.
Br J Radiol. 2019 Oct;92(1102):20190209. doi: 10.1259/bjr.20190209. Epub 2019 Jul 9.
Nasopharyngeal carcinoma (NPC) is a malignancy with unique clinical biological profiles such as associated Epstein-Barr virus infection and high radiosensitivity. Radiotherapy has long been recognized as the mainstay for the treatment of NPC. However, the further efficacy brought by radical radiotherapy has reached the bottleneck in advanced patients, who are prone to develop recurrence and distant metastasis after treatment. The application of photon therapy makes it possible for radiation dose escalation in refractory cases and may provide second chance for recurrent patients with less unrecoverable tissue damage. The concept of adaptive radiotherapy is put forward in consideration of target volume shrinkage during treatment. The replanning procedure offers better protection for the organ at risk. However, the best timing and candidates for adaptive radiotherapy is still under debate. The current tendency of artificial intelligence in NPC mainly focuses on image recognition, auto-segmentation and dose prediction. Although artificial intelligence is still in developmental stage, the future of it is promising.To further improve the efficacy of NPC, multimodality treatment is encouraged. In-depth studies on genetic and epigenetic variations help to explain the great heterogeneity among patients, and could further be applied to precise screening and prediction, personalized radiotherapy and the evolution of targeted drugs. Given the clinical benefit of immunotherapy in other cancers, the application of immunotherapy, especially immune checkpoint inhibitor, in NPC is also of great potential. Results from ongoing clinical trials combining immunotherapy with radiotherapy in NPC are expected.
鼻咽癌（NPC）是一种具有独特临床生物学特征的恶性肿瘤，如与 Epstein-Barr 病毒感染相关和高放射敏感性。放射治疗长期以来一直被认为是 NPC 治疗的主要手段。然而，根治性放疗带来的进一步疗效在晚期患者中已达到瓶颈，这些患者在治疗后容易复发和发生远处转移。光子治疗的应用使得在难治性病例中进行辐射剂量升级成为可能，并可能为复发患者提供较少无法挽回的组织损伤的第二次机会。适应性放疗的概念是考虑到治疗过程中靶区缩小而提出的。重新规划过程为危及器官提供了更好的保护。然而，适应性放疗的最佳时机和候选者仍存在争议。人工智能在 NPC 中的当前趋势主要集中在图像识别、自动分割和剂量预测上。尽管人工智能仍处于发展阶段，但它的未来前景广阔。为了进一步提高 NPC 的疗效，鼓励采用多模态治疗。对遗传和表观遗传变异的深入研究有助于解释患者之间的巨大异质性，并可进一步应用于精确筛选和预测、个体化放疗和靶向药物的进化。鉴于免疫疗法在其他癌症中的临床获益，免疫疗法，特别是免疫检查点抑制剂，在 NPC 中的应用也具有很大的潜力。预计正在进行的将免疫疗法与 NPC 中的放疗相结合的临床试验将产生结果。
