Mittal Abhenil, Sharma Atul
Department of Medical Oncology, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India.
J Chemother. 2022 Feb;34(1):9-24. doi: 10.1080/1120009X.2021.1955201. Epub 2021 Jul 24.
There are several controversies in the management of head and neck cancer (SCCHN). Although combined modality treatment is standard in locally advanced SCCHN (LA-SCCHN), the optimal timing of chemotherapy has been debated. Toxicity concerns with chemoradiation (CRT) using high dose cisplatin have prompted use of less intensive approaches. Weekly cisplatin and targeted therapies have been explored in randomized trials. Benefit of neoadjuvant chemotherapy in LA-SCCHN is debated due to lack of impact on overall survival, however, it remains a viable option in the Indian setting where many patients are not eligible for upfront surgery or definite CRT due to advanced stage and poor performance status (PS). The complexity of data of immune check point inhibitors (ICPi) in metastatic setting needs cautious interpretation till an ideal biomarker for their benefit is identified. Their significant cost and promising data of oral metronomic therapy has made the treatment landscape of metastatic SCCHN even more complex. To address these burning issues, we did a critical review of evidence of systemic therapy in SCCHN.
头颈部鳞状细胞癌（SCCHN）的治疗存在若干争议。尽管联合治疗模式是局部晚期SCCHN（LA - SCCHN）的标准治疗方法，但化疗的最佳时机一直存在争议。对使用高剂量顺铂的放化疗（CRT）的毒性担忧促使人们采用强度较低的治疗方法。在随机试验中探索了每周一次的顺铂治疗和靶向治疗。由于对总生存期没有影响，LA - SCCHN中新辅助化疗的益处存在争议，然而，在印度的情况下，它仍然是一个可行的选择，因为许多患者由于疾病晚期和较差的体能状态（PS）而不符合 upfront 手术或确定性CRT的条件。在确定免疫检查点抑制剂（ICPi）在转移性情况下的理想生物标志物之前，其数据的复杂性需要谨慎解读。它们高昂的成本以及口服节拍器疗法的有前景的数据使得转移性SCCHN的治疗格局更加复杂。为了解决这些紧迫问题，我们对头颈部鳞状细胞癌全身治疗的证据进行了批判性综述。
