Strohl Madeleine P, Wai Katherine C, Ha Patrick K
Division of Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA.
Ann Transl Med. 2020 Dec;8(23):1601. doi: 10.21037/atm-20-2984.
Human papillomavirus-related (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is a relatively new clinical entity that is dramatically on the rise globally. HPV+ OPSCC is thought to be a separate clinical entity compared to HPV- OPSCC with a distinct tumor biology. Patients with HPV associated disease have been shown to have a substantially better prognosis and overall survival than those patients with the HPV negative (HPV-) counterpart. The standard of care for OPSCC is definitive radiation therapy (RT) and concurrent chemoradiation therapy (CRT), for lower and higher stage disease, respectively. However, traditional CRT is also associated with severe acute and late toxicities affecting patient quality of life, such as severe mucositis, dry mouth and dysphagia. Considering that HPV+ OPSCC is on the rise in a younger, healthier patient population and the good prognosis of HPV-related disease, there has been a focus on reducing treatment toxicities and optimizing quality of life while maintaining favorable oncologic outcomes. A variety of such de-escalation regimens are currently being explored in recently completed and ongoing clinical trials. Alterations to the standard chemotherapy, radiation and surgical regimens are being explored. This review will provide an overview of the rationale for and available results of the major de-intensification strategies in the treatment of locally advanced HPV+ OPSCC.
人乳头瘤病毒相关（HPV+）口咽鳞状细胞癌（OPSCC）是一种相对较新的临床实体，在全球范围内急剧上升。与HPV- OPSCC相比，HPV+ OPSCC被认为是一种具有独特肿瘤生物学特性的独立临床实体。已证明HPV相关疾病患者的预后和总生存率明显优于HPV阴性（HPV-）患者。OPSCC的标准治疗方法分别是针对低分期和高分期疾病的根治性放射治疗（RT）和同步放化疗（CRT）。然而，传统的CRT也会带来严重的急性和晚期毒性，影响患者的生活质量，如严重的粘膜炎、口干和吞咽困难。鉴于HPV+ OPSCC在更年轻、更健康的患者群体中呈上升趋势，且HPV相关疾病预后良好，人们一直致力于在保持良好肿瘤学结果的同时降低治疗毒性并优化生活质量。目前，在最近完成和正在进行的临床试验中正在探索多种此类降阶梯方案。正在探索对标准化疗、放疗和手术方案的改变。本综述将概述局部晚期HPV+ OPSCC治疗中主要降强化策略的基本原理和现有结果。
