Mireștean Camil Ciprian, Crișan Anda, Mitrea Adina, Buzea Călin, Iancu Roxana Irina, Iancu Dragoș Petru Teodor
Department of Oncology and Radiotherapy, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania.
C.F. Clinical Hospital, 700506 Iași, Romania.
J Clin Med. 2021 Feb 4;10(4):587. doi: 10.3390/jcm10040587.
Locally advanced head and neck cancer is a unique challenge for cancer management in the Covid-19 situation. The negative consequences of delaying radio-chemotherapy treatment make it necessary to prioritize these patients, the continuation of radiotherapy being indicated even if SARS-CoV-2 infection is confirmed in the case of patients with moderate and mild symptoms. For an early scenario, the standard chemo-radiotherapy using simultaneous integrated boost (SIB) technique is the preferred option, because it reduces the overall treatment time. For a late scenario with limited resources, hypo-fractionated treatment, with possible omission of chemotherapy for elderly patients and for those who have comorbidities, is recommended. Concurrent chemotherapy is controversial for dose values >2.4 Gy per fraction. The implementation of hypo-fractionated regimens should be based on a careful assessment of dose-volume constraints for organs at risks (OARs), using recommendations from clinical trials or dose conversion based on the linear-quadratic (LQ) model. Induction chemotherapy is not considered the optimal solution in this situation because of the risk of immunosuppression even though in selected groups of patients TPF regimen may bring benefits. Although the MACH-NC meta-analysis of chemotherapy in head and neck cancers did not demonstrate the superiority of induction chemotherapy over concurrent chemoradiotherapy, an induction regimen could be considered for cases with an increased risk of metastasis even in the case of a possible Covid-19 pandemic scenario.
局部晚期头颈癌在新冠疫情背景下的癌症管理中是一项独特的挑战。延迟放化疗治疗的负面后果使得必须优先处理这些患者，即便确诊感染了SARS-CoV-2，对于症状较轻和中度的患者，放疗仍应继续。对于早期情况，采用同步整合加量（SIB）技术的标准放化疗是首选方案，因为它能缩短总体治疗时间。对于资源有限的晚期情况，推荐采用大分割治疗，对于老年患者和有合并症的患者可省略化疗。对于每次分割剂量>2.4 Gy的情况，同步化疗存在争议。大分割方案的实施应基于对危及器官（OARs）剂量体积限制的仔细评估，可采用临床试验的建议或基于线性二次（LQ）模型的剂量转换。诱导化疗在这种情况下不被视为最佳解决方案，因为存在免疫抑制风险，尽管在特定患者群体中TPF方案可能带来益处。尽管MACH-NC对头颈癌化疗的荟萃分析未显示诱导化疗优于同步放化疗，但即使在可能出现新冠疫情的情况下，对于转移风险增加的病例，仍可考虑采用诱导方案。
