Kut Carmen, Quon Harry, Chen Xuguang Scott
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC 27599, USA.
Cancers (Basel). 2024 Dec 12;16(24):4150. doi: 10.3390/cancers16244150.
Radiotherapy (RT) is an integral component in the multidisciplinary management of patients with head and neck squamous cell carcinoma (HNSCC). Significant advances have been made toward optimizing tumor control and toxicity profiles of RT for HNSCC in the past two decades. The development of intensity modulated radiotherapy (IMRT) and concurrent chemotherapy established the standard of care for most patients with locally advanced HNSCC around the turn of the century. More recently, selective dose escalation to the most radioresistant part of tumor and avoidance of the most critical substructures of organs at risk, often guided by functional imaging, allowed even further improvement in the therapeutic ratio of IMRT. Other highly conformal RT modalities, including intensity modulated proton therapy (IMPT) and stereotactic body radiotherapy (SBRT) are being increasingly utilized, although there are gaps in our understanding of the normal tissue complication probabilities and their relative biological effectiveness. There is renewed interest in spatially fractionated radiotherapy (SFRT), such as GRID and LATTICE radiotherapy, in both palliative and definitive settings. The emergence of immune checkpoint inhibitors (ICIs) has revolutionized the treatment of patients with recurrent and metastatic HNSCC. Novel RT modalities, including IMPT, SBRT, and SFRT, have the potential to reduce lymphopenia and immune suppression, stimulate anti-tumor immunity, and synergize with ICIs. The next frontier in the treatment of HNSCC may lie in the exploration of combined modality treatment with new RT technologies and ICIs.
放射治疗（RT）是头颈部鳞状细胞癌（HNSCC）患者多学科管理的一个重要组成部分。在过去二十年中，在优化HNSCC的放射治疗的肿瘤控制和毒性方面取得了重大进展。调强放射治疗（IMRT）和同步化疗的发展在世纪之交确立了大多数局部晚期HNSCC患者的治疗标准。最近，在功能成像的指导下，对肿瘤最具放射抗性的部分进行选择性剂量递增，并避免危及器官的最关键亚结构，使得IMRT的治疗比得到了进一步改善。其他高度适形的放射治疗方式，包括调强质子治疗（IMPT）和立体定向体部放射治疗（SBRT），正越来越多地被使用，尽管我们对正常组织并发症概率及其相对生物学效应的理解还存在差距。在姑息和根治性治疗中，对空间分割放射治疗（SFRT），如格栅放疗和点阵放疗，重新产生了兴趣。免疫检查点抑制剂（ICI）的出现彻底改变了复发和转移性HNSCC患者的治疗方式。新型放射治疗方式，包括IMPT、SBRT和SFRT，有可能减少淋巴细胞减少和免疫抑制，刺激抗肿瘤免疫，并与ICI协同作用。HNSCC治疗的下一个前沿领域可能在于探索新的放射治疗技术与ICI的联合治疗模式。
