Department of Radiation Oncology, Stanford University, Stanford, CA.
Department of Radiation Oncology, Stanford University, Stanford, CA.
Semin Radiat Oncol. 2023 Jul;33(3):336-347. doi: 10.1016/j.semradonc.2023.03.013.
Head and neck cancer is notoriously challenging to treat in part because it constitutes an anatomically and biologically diverse group of cancers with heterogeneous prognoses. While treatment can be associated with significant late toxicities, recurrence is often difficult to salvage with poor survival rates and functional morbidity. Thus, achieving tumor control and cure at the initial diagnosis is the highest priority. Given the differing outcome expectations (even within a specific sub-site like oropharyngeal carcinoma), there has been growing interest in personalizing treatment: de-escalation in selected cancers to decrease the risk of late toxicity without compromising oncologic outcomes, and intensification for more aggressive cancers to improve oncologic outcomes without causing undue toxicity. This risk stratification is increasingly accomplished using biomarkers, which can represent molecular, clinicopathologic, and/or radiologic data. In this review, we will focus on biomarker-driven radiotherapy dose personalization with emphasis on oropharyngeal and nasopharyngeal carcinoma. This radiation personalization is largely performed on the population level by identifying patients with good prognosis via traditional clinicopathologic factors, although there are emerging studies supporting inter-tumor and intra-tumor level personalization via imaging and molecular biomarkers.
头颈部癌症的治疗极具挑战性，部分原因是它由一组解剖学和生物学上具有异质性预后的癌症组成。虽然治疗可能会导致严重的晚期毒性，但由于生存率和功能发病率低，复发通常难以挽救。因此，在初始诊断时实现肿瘤控制和治愈是重中之重。鉴于不同的预后期望（即使在特定的亚部位，如口咽癌），人们越来越关注治疗的个体化：在选定的癌症中降低晚期毒性的风险而不影响肿瘤学结果的下调，以及为更具侵袭性的癌症强化以提高肿瘤学结果而不引起不必要的毒性。这种风险分层越来越多地使用生物标志物来完成，生物标志物可以代表分子、临床病理和/或影像学数据。在这篇综述中，我们将重点关注基于生物标志物的放射治疗剂量个体化，重点关注口咽癌和鼻咽癌。这种放射治疗的个体化主要是通过传统的临床病理因素识别具有良好预后的患者在人群水平上进行的，尽管有一些新兴的研究支持通过影像学和分子生物标志物进行肿瘤间和肿瘤内水平的个体化。
