Tang É, Nguyen T-V-F, Clatot F, Rambeau A, Johnson A, Sun X S, Tao Y, Thariat J
Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
Département d'oncologie médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76038 Rouen, France.
Cancer Radiother. 2020 Oct;24(6-7):559-566. doi: 10.1016/j.canrad.2020.05.004. Epub 2020 Aug 1.
Patients with synchronous metastatic head and neck squamous cell carcinomas often present associated locoregional symptoms and a risk of life-threatening primary tumour progression. Few data have been published about the use of radiation therapy in the management of newly diagnosed metastatic disease associated with advanced locoregional disease. In this article, we aim to determine the role of radiation therapy of the primary tumour in the overall therapeutic strategy for these diseases. We further address radiation therapy modalities (technique, volumes, and fractionation) in such a context.
We conducted a literature survey on locoregional radiotherapy for newly diagnosed metastatic head and neck squamous cell carcinomas.
Several retrospective studies have reported that locoregional radiotherapy is associated with improved overall survival of patients with synchronous metastatic head and neck squamous cell carcinomas. However, data about modalities such as timing of radiotherapy in the overall strategy, dose, fractionation and delineation volumes are scarce. Two schematic situations can be distinguished with respect to prognosis and treatment adaptations: polymetastatic/bulky or oligometastatic disease. In polymetastic/bulky disease associated with poor prognosis, standard-of-care is systemic therapy, but locoregional radiotherapy can be discussed either upfront, mainly for symptomatic palliation, or as consolidation after downsizing obtained by systemic therapy. As for oligometastatic disease, with the rise in use of efficacious and well-tolerated local ablative treatments of metastases, aggressive curative-intent locoregional radiotherapy can be considered with or without systemic therapy.
Because locoregional disease is a major cause of disease failure in patients with synchronous metastatic head and neck squamous cell carcinomas, aggressive locoregional radiation therapy to the primary tumour may be discussed in the initial management of the disease where systemic therapy alone may not induce sufficient primary tumour reduction. With recent technological advances in radiotherapy, the delivery of radiotherapy is safe and feasible even in metastatic setting. Clinical trials assessing radiotherapy use for metastatic head and neck squamous cell carcinomas are warranted.
同步性转移性头颈部鳞状细胞癌患者常伴有局部区域症状，且存在危及生命的原发性肿瘤进展风险。关于放射治疗在新诊断的与晚期局部区域疾病相关的转移性疾病管理中的应用，鲜有数据发表。在本文中，我们旨在确定原发性肿瘤放射治疗在这些疾病的整体治疗策略中的作用。我们还将探讨在这种情况下的放射治疗模式（技术、靶区体积和分割方式）。
我们对新诊断的转移性头颈部鳞状细胞癌的局部区域放射治疗进行了文献调查。
多项回顾性研究报告称，局部区域放射治疗与同步性转移性头颈部鳞状细胞癌患者的总生存期改善相关。然而，关于放射治疗在整体策略中的时机、剂量、分割方式和靶区勾画等模式的数据却很匮乏。就预后和治疗调整而言，可以区分两种大致情况：多灶性/体积较大或寡转移性疾病。在预后较差的多灶性/体积较大疾病中，标准治疗是全身治疗，但局部区域放射治疗可以在治疗初期进行讨论，主要用于缓解症状，或者在通过全身治疗使肿瘤缩小后作为巩固治疗。至于寡转移性疾病，随着有效且耐受性良好的局部转移性消融治疗的应用增加，可以考虑采用积极的根治性局部区域放射治疗，无论是否联合全身治疗。
由于局部区域疾病是同步性转移性头颈部鳞状细胞癌患者疾病失败的主要原因，对于仅采用全身治疗可能无法充分缩小原发性肿瘤的疾病，在初始治疗中可考虑对原发性肿瘤进行积极的局部区域放射治疗。随着放射治疗技术的最新进展，即使在转移性情况下，放射治疗的实施也是安全可行的。有必要开展评估放射治疗在转移性头颈部鳞状细胞癌中应用的临床试验。
