Predicting Recurrence After Radiotherapy in Head and Neck Cancer
Predicting Recurrence After Radiotherapy in Head and Neck Cancer
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DOI：
10.1016/j.semradonc.2011.12.002
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发表时间：
2012-04-01
影响因子：
3.5
通讯作者：
Begg, Adrian C.
中科院分区：
文献类型：
--
作者：
Begg, Adrian C.
头颈鳞状细胞癌（HNSCC）是全球第六大常见癌症。放射治疗是主要的治疗方法，无论是单独治疗早期肿瘤还是联合化疗治疗晚期肿瘤。 HNSCC 的总体 5 年生存率约为 50%，这表明治疗往往不成功。因此，结果预测一方面旨在使患者免受无效和有毒的治疗，另一方面表明更成功的治疗方式。功能和遗传测定已被开发用于预测内在放射敏感性、缺氧和繁殖率。然而，很少有研究显示出与多项研究结果一致的相关性。信使 RNA 和 microRNA 分析显示出预测缺氧的前景，而表皮生长因子受体表达与肿瘤分化等级的其他测量相结合显示出预测增殖率的前景。尽管修复蛋白焦点测定的发展表明了临床前研究的希望，但迄今为止，内在放射敏感性测定尚未被证明有用。癌症干细胞含量的测定在多项临床研究中显示出了前景。此外，人乳头状瘤病毒状态和表皮生长因子受体表达作为 HNSCC 结果预测因子的 2 项检测显示出稳健性。然而，这些检测和干细胞检测都无法可靠地为预后不良的患者提供替代和更好的治疗方法。进行预测通过将新的分子靶向药物与放射疗法相结合以增加反应对个体的益处的测定，特别是那些利用肿瘤突变来提供肿瘤特异性的测定，将具有很大的价值。目前正在开发预测检测方法，用于检测单链和双链 DNA 断裂修复途径中的缺陷，这将允许选择针对适当备用途径的药物，从而利用合成致死的概念。无论是当前还是未来，这都是最有前途的预测领域之一。 Semin Radiat Oncol 22:108-118 (c) 2012 爱思唯尔公司出版
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide. Radiotherapy is a mainstay of treatment, either alone for early stage tumors or combined with chemotherapy for late stage tumors. An overall 5-year survival rate of around 50% for HNSCC demonstrates that treatment is often unsuccessful. Prediction of outcome is, therefore, aimed at sparing patients from ineffective and toxic treatments on the one hand, and indicating more successful treatment modalities on the other. Both functional and genetic assays have been developed to predict intrinsic radiosensitivity, hypoxia, and repopulation rate. Few, however, have shown consistent correlations with outcome across multiple studies. Messenger RNA and microRNA profiling show promise for predicting hypoxia, whereas epidermal growth factor receptor expression combined with other measures of tumor differentiation grade shows promise for predicting repopulation rate. Intrinsic radiosensitivity assays have not proven useful to date, although development of repair protein foci assays indicates promise from preclinical studies. Assays for cancer stem cell content have shown promise in several clinical studies. In addition, 2 assays showing robustness as predictors for outcome in HNSCC are human papilloma virus status and epidermal growth factor receptor expression. Neither these nor stem cell assays, however, can as yet reliably indicate alternative and better treatments for poor prognosis patients. It would be of great value to have assays that predict the benefit for an individual from combining new molecularly targeted agents with radiotherapy to increase response, in particular those that exploit tumor mutations to provide tumor specificity. Predictive assays are being developed for detecting defects in repair pathways for single- and double-strand DNA breaks, which should allow selection of drugs targeting the appropriate backup pathway, thus exploiting the concept of synthetic lethality. This is one of the most promising areas for prediction, both currently and in the future. Semin Radiat Oncol 22:108-118 (c) 2012 Published by Elsevier Inc.