Advances in Diagnosis and Multidisciplinary Management of Oropharyngeal Squamous Cell Carcinoma: State of the Art.
Advances in Diagnosis and Multidisciplinary Management of Oropharyngeal Squamous Cell Carcinoma: State of the Art.
复制标题
口咽鳞状细胞癌的诊断和多学科治疗进展：最新技术。
作者：
U. Parvathaneni;P. Lavertu;M. Gibson;C. Glastonbury
在过去的15年里，口咽鳞状细胞癌(OPSCC)的最常见原因已从烟草和酒精转移到人类乳头瘤病毒(HPV)。HPV驱动的p16阳性OPSCC和与烟草相关的OPSCC在潜在的分子和遗传学特征、社会经济人口统计学和治疗反应方面存在差异。HPV相关的OPSCC多发生在较年轻的患者中，对治疗的反应明显较好，预后良好。预后方面的鲜明对比--HPV相关p16阳性OPSCC的总5年生存率约为90%，非HPV相关p16阴性OPSCC的总5年生存率约为40%--促使美国癌症联合委员会(AJCC)第八版的分期手册做出了重大改变。在过去的10-15年里，外科手术、放射治疗(RT)和全身治疗也取得了重大进展。随着口腔机器人手术和激光显微外科手术的出现，微创手术已经成熟。调强适形放射治疗(IMRT)和最近的质子束适形放射治疗显著提高了适形放射治疗的一致性，能够精确地靶向肿瘤和荷癌区域，同时保留了正常结构，显著降低了长期治疗相关的发病率。全身治疗的进展是以免疫治疗和靶向药物如西妥昔单抗的形式出现的。由于HPV驱动的OPSCC预后较好，以及与治疗相关的发病率，人们正在探索通过多种策略降低治疗的难度。本文回顾了HPV时代OPSCC的诊断和多学科治疗的进展。
During the past decade and a half, the most common cause of oropharyngeal squamous cell carcinoma (OPSCC) has shifted from tobacco and alcohol to the human papillomavirus (HPV). HPV-driven p16-positive OPSCC and tobacco-related OPSCC differ in their underlying molecular and genetic profiles, socioeconomic demographics, and response to treatment. HPV-related OPSCC tends to occur in younger patients and has a significantly better response to treatment and excellent prognosis. The stark contrast in prognosis-with around 90% overall 5-year survival for HPV-related p16-positive OPSCC and 40% for non-HPV-related p16-negative OPSCC-has prompted major changes in the eighth edition of the staging manual of the AJCC (American Joint Committee on Cancer). The past 10-15 years have also witnessed major advances in surgery, radiation therapy (RT), and systemic therapy. Minimally invasive surgery has come of age, with transoral robotic procedures and laser microsurgery. Intensity-modulated RT (IMRT) and more recently proton-beam RT have markedly improved the conformity of RT, with an ability to precisely target the cancer and cancer-bearing regions while sparing normal structures and significantly reducing long-term treatment-related morbidity. Progress in systemic therapy has come in the form of immunotherapy and targeted agents such as cetuximab. Owing to the better prognosis of HPV-driven OPSCC as well as the morbidity associated with treatment, de-escalation of therapy via multiple strategies is being explored. The article reviews the advances in diagnosis and multidisciplinary management of OPSCC in the HPV era.©RSNA, 2019.
DOI：
10.1016/j.ijrobp.2009.07.1708
发表时间：
2010-10-01
影响因子：
7
作者：
Dijkema, Tim;Raaijmakers, Cornelis P. J.;Ten Haken, Randall K.;Roesink, Judith M.;Braam, Petra M.;Houweling, Anette C.;Moerland, Marinus A.;Eisbruch, Avraham;Terhaard, Chris H. J.
通讯作者：
Terhaard, Chris H. J.
影响因子：
10.3
作者：
Gillison, ML;Koch, WM;Sidransky, D
通讯作者：
Sidransky, D