Szturz Petr, Haddad Robert I, Posner Marshall, Vermorken Jan B
Department of Oncology, University of Lausanne and Lausanne University Hospital, 1011 Lausanne, Switzerland.
Department of Medical Oncology, Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, United States.
Oncologist. 2025 May 8;30(5). doi: 10.1093/oncolo/oyaf035.
Patients with head and neck cancer often present with complex challenges due to a substantial comorbidity burden, including substance use disorders, and the tumor's location in regions that are both cosmetically and anatomically sensitive. These challenges can be categorized into 6 areas, that is, overall health (eg, performance status, biological age), physiological life stages (eg, aging), organ dysfunctions (including autoimmune comorbidities, organ transplants, and psychiatric disorders), previous and concurrent malignancies, previous and current therapies, and adherence to therapy. We provide a practical guide to help physicians understand and address the phenotypic multitude of potential complications in the management of these patients. The process has 4 main phases involving identification of the clinical challenge, understanding the reasons for ineligibility (contraindications), assessment of the risk to benefit ratio, and finally making informed decisions about systemic treatment. Proactive interventions, including prehabilitation, are crucial for optimizing patient outcomes and reversing some ineligibility issues. The evidence supporting contraindications is drawn from both clinical trials and real-world data, each with its strengths and limitations. These contraindications are applied as absolute or relative and further refined by expert opinions and consensus statements. There are 2 main reasons for ineligibility for a given treatment, absence of supporting data or negative outcome data. In these cases, careful interpretation using all levels of clinical evidence, including extrapolation and preclinical rationale, is essential. By mastering these skills, that may in the future be enhanced by artificial intelligence methods, significant advancements in patient care can be achieved.
头颈癌患者常常面临复杂的挑战，这是由于其存在大量合并症负担，包括物质使用障碍，以及肿瘤位于面部美观和解剖结构敏感的区域。这些挑战可分为6个领域，即总体健康状况（如体能状态、生物学年龄）、生理生命阶段（如衰老）、器官功能障碍（包括自身免疫性合并症、器官移植和精神疾病）、既往和并发恶性肿瘤、既往和当前治疗，以及对治疗的依从性。我们提供一份实用指南，以帮助医生理解并应对这些患者管理中众多潜在并发症的表型。该过程有4个主要阶段，包括识别临床挑战、理解不符合条件的原因（禁忌症）、评估风险效益比，以及最终就是否进行全身治疗做出明智决策。包括预康复在内的积极干预措施对于优化患者预后和扭转一些不符合条件的问题至关重要。支持禁忌症的证据来自临床试验和真实世界数据，两者各有优缺点。这些禁忌症分为绝对禁忌症或相对禁忌症，并通过专家意见和共识声明进一步细化。给定治疗不符合条件有2个主要原因，即缺乏支持数据或有负面结果数据。在这些情况下，使用所有级别的临床证据进行仔细解读，包括外推法和临床前理论依据，至关重要。通过掌握这些技能（未来可能会借助人工智能方法得到加强），可以在患者护理方面取得重大进展。
