Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
Curr Oncol. 2023 Jul 14;30(7):6708-6719. doi: 10.3390/curroncol30070492.
Radiation therapy (RT) is a mainstay for the treatment of head and neck (HN) cancers, with 80% of patients receiving such treatment. Radiation-induced malignancies represent a life-threatening long-term effect of RT, with an incidence of 0.5% to 15%.
After 13 years, a 33-year-old woman treated with chemo-radiotherapy for nasopharyngeal carcinoma developed a locally advanced, radiation-induced, p16-negative oropharyngeal squamous cell carcinoma (SCC) at the base of the tongue. Chemo/immunotherapy was administered as a first-line treatment. Given the optimal response and the feasibility of surgery, after three cycles, the patient underwent a total glossectomy, bilateral neck dissection, and reconstruction with a thoraco-dorsal free flap. A histological examination found SCC with a residual cancer burden of 70% and free margins.
The mechanisms responsible for carcinogenesis after RT are still not completely clear. Diagnosis may be challenging due to the previous treatment; growth patterns are unusual, and lymphotropism is lower. Prognosis is usually poor since surgical resectability is often not achievable.
Radiation-induced malignancies are difficult to treat. Patient management should always be discussed at a multidisciplinary level. Future research is needed to assess whether the promising results of clinical studies with pre-operative immunotherapy in locally advanced HN SCC patients may be translated into radiation-induced cancers.
放射治疗（RT）是治疗头颈部（HN）癌症的主要方法，80%的患者接受这种治疗。放射诱导的恶性肿瘤是 RT 的一种危及生命的长期效应，发病率为 0.5%至 15%。
一名 33 岁的女性患者因鼻咽癌接受了化疗和放疗，13 年后在舌根部发展为局部晚期、放射诱导的 p16 阴性口咽鳞状细胞癌（SCC）。给予化疗/免疫治疗作为一线治疗。鉴于最佳反应和手术的可行性，在三个周期后，患者接受了全舌切除术、双侧颈部清扫术和胸背游离皮瓣重建。组织学检查发现 SCC 残留癌症负担为 70%，切缘无肿瘤。
RT 后致癌的机制仍不完全清楚。由于先前的治疗，诊断可能具有挑战性；生长模式不常见，淋巴亲嗜性较低。由于手术可切除性通常无法实现，因此预后通常较差。
放射诱导的恶性肿瘤难以治疗。患者管理应始终在多学科层面进行讨论。需要进一步研究以评估局部晚期 HN SCC 患者术前免疫治疗的临床研究中令人鼓舞的结果是否可以转化为放射诱导的癌症。
