The future of personalised radiotherapy for head and neck cancer.
The future of personalised radiotherapy for head and neck cancer.
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DOI：
10.1016/s1470-2045(17)30252-8
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发表时间：
2017-05
期刊：
影响因子：
--
通讯作者：
Harrison LB
中科院分区：
文献类型：
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作者：
Caudell JJ;Torres-Roca JF;Gillies RJ;Enderling H;Kim S;Rishi A;Moros EG;Harrison LB
放射治疗长期以来一直是头颈癌患者的主要治疗方法，传统上涉及分期依赖策略，即所有具有相同TNM阶段的患者接受相同的治疗。我们相信，除了技术和解剖精度之外，还有大量的机会来改善放射治疗的递送。在本系列论文中，我们探讨了一些新的想法，可以提高对患者及其肿瘤之间存在的表型和基因型差异的理解。我们讨论了如何利用这些差异和利用精确医学工具——如基因组学、放射组学和数学模型——可以为个性化放疗适应和治疗打开新的大门。我们提出了一个新的治疗转变，从经验剂量和分离的时代转移到一个专注于证据发展的时代，以指导个性化和放射治疗的生物适应性。我们相信这些方法提供了改善结果和减少毒性的潜力。
Radiotherapy has long been the mainstay of treatment for patients with head and neck cancer and has traditionally involved a stage-dependent strategy whereby all patients with the same TNM stage receive the same therapy. We believe there is a substantial opportunity to improve radiotherapy delivery beyond just technological and anatomical precision. In this Series paper, we explore several new ideas that could improve understanding of the phenotypic and genotypic differences that exist between patients and their tumours. We discuss how exploiting these differences and taking advantage of precision medicine tools—such as genomics, radiomics, and mathematical modelling—could open new doors to personalised radiotherapy adaptation and treatment. We propose a new treatment shift that moves away from an era of empirical dosing and fractionation to an era focused on the development of evidence to guide personalisation and biological adaptation of radiotherapy. We believe these approaches offer the potential to improve outcomes and reduce toxicity.