Kreinbrink Paul J, Lewis Luke M, Redmond Kevin P, Takiar Vinita
University of Cincinnati Departments of Radiation Oncology, Cincinnati, OH, USA.
Cincinnati VA Medical Center, Cincinnati, OH, USA.
Curr Treat Options Oncol. 2022 Mar;23(3):295-310. doi: 10.1007/s11864-021-00936-y. Epub 2022 Feb 28.
Recurrent and second primary head and neck cancers represent a clinical challenge due to frequently unresectable and/or locally advanced disease. Given that many of these patients have received definitive doses of radiation previously, reirradiation is associated with significant morbidity. Use of modern approaches such as conformal photon-based planning and charged particle therapy using protons or carbon ions allows for greater sparing of normal tissues while maintaining or escalating doses to tumor volumes. While the reirradiation data has consistently shown benefits to local control and even survival from escalation of radiotherapy dose, excessive cumulative doses can result in severe toxicities, including fatal carotid blowout syndrome. For all modalities, appropriate patient selection is of utmost importance. Large-scale trials and multi-institutional registry data are needed to standardize treatment modalities, and to determine optimal doses and volumes for reirradiation.
复发性和第二原发性头颈癌是一项临床挑战，因为疾病常常无法切除和/或处于局部晚期。鉴于这些患者中的许多人之前已接受了根治性放疗剂量，再次放疗会带来显著的发病率。使用现代方法，如基于适形光子的计划以及使用质子或碳离子的带电粒子治疗，在维持或提高肿瘤体积剂量的同时，能够更好地保护正常组织。虽然再次放疗数据一直显示提高放疗剂量对局部控制甚至生存有益，但过高的累积剂量会导致严重毒性，包括致命的颈动脉破裂综合征。对于所有治疗方式，恰当的患者选择至关重要。需要大规模试验和多机构登记数据来规范治疗方式，并确定再次放疗的最佳剂量和体积。
