Department of Otorhinolaryngology, Humanitas Clinical and Research Center-IRCCS, Viale Manzoni 56, Rozzano, MI, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, MI, Italy.
Curr Oncol Rep. 2020 Jul 9;22(9):91. doi: 10.1007/s11912-020-00948-1.
The treatment of patients with squamous cell carcinoma of the oropharynx (OPSCC) remains controversial. HPV positivity is widely accepted as a favorable prognostic factor, and HPV+ OPSCC is considered a distinct pathological entity with dedicated NCCN guidelines and may deserve a more personalized therapeutic strategy. The possibility to reduce surgical invasiveness and acute and late toxicity of radiotherapy/chemotherapy has led to the new concept of de-escalation treatment strategies. In particular, several de-intensified approaches have been investigated with the aim to give patients less toxic treatments, while maintaining comparable results in terms of disease's control and survival. The aim of the present review is to systematically illustrate the current status of research in de-intensification surgical and non-surgical strategies in the treatment of the OPSCC.
We categorized all completed and on-going trials on the basis of the specific de-escalated treatment protocol. Several de-intensified approaches have been investigated with the aim to give patients less toxic treatments, while maintaining comparable results in terms of disease's control and survival. Considering the conflicting results reported so far by preliminary studies, it is necessary to wait for the final results of the on-going trials to better clarify which is the best de-intensified strategy and which patients would really benefit from it.
目的综述：口咽鳞状细胞癌（OPSCC）的治疗仍然存在争议。HPV 阳性被广泛认为是一种有利的预后因素，HPV+ OPSCC 被认为是一种独特的病理实体，有专门的 NCCN 指南，可能需要更个性化的治疗策略。减少放疗/化疗的手术侵袭性和急性及迟发性毒性的可能性导致了新的降阶治疗策略的概念。特别是，已经研究了几种减量化方法，目的是为患者提供毒性较小的治疗，同时在疾病控制和生存方面保持可比的结果。本综述的目的是系统地说明 OPSCC 治疗中降阶手术和非手术策略的研究现状。
最新发现：我们根据特定的降阶治疗方案对所有已完成和正在进行的试验进行了分类。已经研究了几种减量化方法，目的是为患者提供毒性较小的治疗，同时在疾病控制和生存方面保持可比的结果。鉴于迄今为止初步研究报告的结果存在冲突，有必要等待正在进行的试验的最终结果，以更好地阐明哪种是最佳的降阶策略，哪种患者真正受益于这种策略。
