Wu Peng, Zhao Yumei, Xiang Li, Yang Linglin
Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, People's Republic of China.
Cancer Manag Res. 2020 Feb 10;12:957-963. doi: 10.2147/CMAR.S239729. eCollection 2020.
Nasopharyngeal carcinoma is an endemic disease with a high prevalence in Southeast Asia, Mediterranean countries, and Northern Africa. With substantial advances in screening and diagnosis, increasingly more early-stage (stage I~II) patients are being diagnosed. The undebated treatment modality for stage I patients is radiotherapy alone. However, controversies exist for patients with stage II disease, mostly revolving around the management of chemotherapy. However, the use of intensity-modulated radiotherapy for the treatment of nasopharyngeal carcinoma has increased recently, which has drastically improved survival outcomes. Thus, many oncologists have considered omitting chemotherapy for stage II patients in the intensity-modulated radiotherapy era. Unfortunately, prospective studies comparing concurrent radio-chemotherapy with intensity-modulated radiotherapy alone are limited. Notably, stage II nasopharyngeal carcinoma consists of three subgroups, among which stage T2N1M0 disease is unique and potentially warrants additional treatment including chemotherapy. Additionally, molecular biology techniques are advancing at an incredible speed. Instead of adopting a one-size-fits-all recommendation, exploring potential predictive biomarkers to select patients who are likely to derive benefit from chemotherapy is a better choice. In this review, we summarize the data from studies and reviews regarding chemotherapy for stage II nasopharyngeal carcinoma in the intensity-modulated radiotherapy era and discuss chemotherapy utility. Eventually, we conclude that IMRT alone may be sufficient for stage II nasopharyngeal carcinoma, but this needs to be verified by prospective studies in the near future, the evidence collected thus far suggests that concurrent chemo-radiotherapy without induction or adjuvant chemotherapy is yet to be necessary for patients with stage II disease.
鼻咽癌是一种在东南亚、地中海国家和北非地区高发的地方性疾病。随着筛查和诊断技术的显著进步，越来越多的早期（I~II期）患者被诊断出来。对于I期患者，毫无争议的治疗方式是单纯放疗。然而，II期患者存在争议，主要围绕化疗的管理。然而，近年来调强放疗用于治疗鼻咽癌的情况有所增加，这极大地改善了生存结果。因此，许多肿瘤学家考虑在调强放疗时代省略II期患者的化疗。不幸的是，比较同步放化疗与单纯调强放疗的前瞻性研究有限。值得注意的是，II期鼻咽癌由三个亚组组成，其中T2N1M0期疾病较为独特，可能需要包括化疗在内的额外治疗。此外，分子生物学技术正以惊人的速度发展。与其采用一刀切的建议，探索潜在的预测生物标志物以选择可能从化疗中获益的患者是更好的选择。在本综述中，我们总结了调强放疗时代关于II期鼻咽癌化疗的研究和综述数据，并讨论化疗的效用。最终，我们得出结论，单纯调强放疗可能足以治疗II期鼻咽癌，但这需要在不久的将来通过前瞻性研究进行验证，迄今为止收集的证据表明，对于II期疾病患者，尚无必要进行同步放化疗而不进行诱导或辅助化疗。
