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[口咽癌:改变规则的病毒]

[OROPHARYNGEAL CANCER: THE VIRUS THAT CHANGED THE RULES].

作者信息

Feibish Nir, Bartal Keren, Doweck Ilana

机构信息

Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Haifa, Israel.

The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

出版信息

Harefuah. 2020 Feb;159(1):137-141.

Abstract

Head and neck cancer is the sixth most common malignancy worldwide. Along with other "classical" risk factors such as tobacco and alcohol use, the human papillomavirus (HPV) is well established to play a pivotal role in the development of head and neck cancers, particularly in oropharyngeal cancer (OPC). While head and neck cancer incidence decline worldwide, OPC is on the rise. The incidence of HPV-positive oropharyngeal carcinoma predominantly increased in younger, married male patients with higher socioeconomic status and with high-risk sexual practices. This OPC subtype is characterized by limited local tumor with a substantially larger regional nodal disease. However, HPV-positive OPC patients exhibited a significantly better prognosis than patients with HPV-negative OPC, leading to a recent change in the clinical guidelines. The current non-surgical standard of care for OPC results in excellent disease control, though associated with substantial toxicity. Numerous studies now focus on less intensive (i.e., deintensified) treatment for the improvement of patient safety while maintaining excellent disease control. Furthermore, the recent development of more advanced surgical techniques with promising outcomes may shift the therapeutic paradigm back to the operating room. During the past decade, there is widespread use of HPV vaccination, and lately, it was also approved for boys. However, the preventive effects of the HPV vaccine on head and neck cancers, particularly on OPC is yet to be determined.

摘要

头颈癌是全球第六大常见恶性肿瘤。除了吸烟和饮酒等其他“经典”风险因素外,人乳头瘤病毒(HPV)在头颈癌的发生发展中起着关键作用,尤其是在口咽癌(OPC)中。虽然全球头颈癌发病率呈下降趋势,但口咽癌发病率却在上升。HPV阳性口咽癌的发病率主要在社会经济地位较高、有高危性行为的年轻已婚男性患者中增加。这种口咽癌亚型的特点是局部肿瘤局限,但区域淋巴结疾病明显更严重。然而,HPV阳性口咽癌患者的预后明显优于HPV阴性口咽癌患者,这导致了近期临床指南的改变。目前口咽癌的非手术标准治疗方法能实现良好的疾病控制,尽管会带来相当大的毒性。现在许多研究集中在强度较低(即去强化)的治疗上,以提高患者安全性,同时保持良好的疾病控制。此外,最近更先进的手术技术取得了有前景的成果,这可能会使治疗模式重新回到手术室。在过去十年中,HPV疫苗得到了广泛使用,最近,它也被批准用于男孩。然而,HPV疫苗对头颈癌,尤其是对口咽癌的预防效果尚未确定。

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