Department of Radiation and Cellular Oncology, The University of Chicago Medicine, Chicago, IL.
Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China.
Semin Radiat Oncol. 2020 Jul;30(3):212-217. doi: 10.1016/j.semradonc.2020.02.002.
Locally recurrent head and neck malignancies after definitive radiation or chemoradiation represent challenging clinical scenarios requiring careful consideration of individualized risks and benefits before deciding upon the next best course of therapy. Herein, a case-based approach to personalized decision making highlights the expert opinions of leaders in head and neck oncology. Topics of interest include optimal candidacy for reirradiation or salvage surgical resection, the judicious use of chemotherapy as induction therapy or as a radiosensitizing agent, the incorporation of immunotherapy into the treatment paradigm for locally recurrent disease, and the impact of various treatment modalities on quality of life and functional outcomes. Interestingly, the lack of consensus among the experts on topics as fundamental as the appropriateness of offering reirradiation at all and as nuanced as target volume delineation for the reirradiated field suggests that there is no straightforward approach in this scenario. Common to all opinions is a desire to maximize the therapeutic ratio for a patient potentially facing a grim prognosis, and honest discussions about goals of care and expectations for post-treatment quality of life should be central to the clinical approach to this and similar cases.
局部复发的头颈部恶性肿瘤经根治性放疗或放化疗后，是具有挑战性的临床情况，在决定下一步最佳治疗方案之前，需要仔细考虑个体风险和获益。本文采用基于病例的方法来个性化决策，突出了头颈部肿瘤学专家的意见。讨论的主题包括再放疗或挽救性手术切除的最佳适应证、化疗作为诱导治疗或放射增敏剂的合理应用、将免疫疗法纳入局部复发性疾病的治疗模式、以及各种治疗方式对生活质量和功能结局的影响。有趣的是，专家们在一些基本问题上缺乏共识，例如是否应进行再放疗，以及再放疗区域的靶区勾画等细节问题，这表明在这种情况下没有简单直接的方法。所有意见的共同点是，希望为可能面临严峻预后的患者最大化治疗效果，并且应该在治疗过程中进行关于治疗目标和治疗后生活质量的坦诚讨论。
