Metastatic disease in head & neck oncology
Metastatic disease in head & neck oncology
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DOI：
10.14639/0392-100x-suppl.1-40-2020
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发表时间：
2020-04-01
影响因子：
2
通讯作者：
Zigliani, Angelo
中科院分区：
文献类型：
--
作者：
Pisani, Paolo;Airoldi, Mario;Zigliani, Angelo
头颈部是最常见的癌症部位之一，在局部区域和远处区域转移的百分比都很高。预后是指几个因素：a）疾病的阶段; B）局部区域复发; c）远处转移。在诊断时，约10%的病例存在头颈癌的远处转移，另外20-30%的病例在其疾病过程中发生转移。远处转移的诊断与预后不良相关，中位生存期约为10个月。本综述的目的是提供头颈部肿瘤远处转移的最新进展。最近在分子分析、肿瘤组织与肿瘤微环境之间的相互作用、寡转移性疾病概念以及免疫治疗的作用方面的成就都深刻地改变了治疗方法和疾病控制。首先，我们探讨的主题，如自然史，流行病学的远处转移和相关的病理和放射学方面。然后重点放在最相关的临床方面，特别注意保留到肿瘤的远处转移和阳性的EBV和HPV，和寡转移的概念。审查的相当大的一部分是致力于不同的治疗方法。我们强调免疫疗法的作用和创新技术的潜在影响。最后，我们提出了与肿瘤患者的脆弱性和可持续社会经济治理中出现的困难有关的伦理和临床观点。
The head and neck district represents one of the most frequent sites of cancer, and the percentage of metastases is very high in both loco-regional and distant areas. Prognosis refers to several factors: a) stage of disease; b) loco-regional relapses; c) distant metastasis. At diagnosis, distant metastases of head and neck cancers are present in about 10% of cases with an additional 20-30% developing metastases during the course of their disease. Diagnosis of distant metastases is associated with unfavorable prognosis, with a median survival of about 10 months. The aim of the present review is to provide an update on distant metastasis in head and neck oncology. Recent achievements in molecular profiling, interaction between neoplastic tissue and the tumor microenvironment, oligometastatic disease concepts, and the role of immunotherapy have all deeply changed the therapeutic approach and disease control. Firstly, we approach topics such as natural history, epidemiology of distant metastases and relevant pathological and radiological aspects. Focus is then placed on the most relevant clinical aspects; particular attention is reserved to tumours with distant metastasis and positive for EBV and HPV, and the oligometastatic concept. A substantial part of the review is dedicated to different therapeutic approaches. We highlight the role of immunotherapy and the potential effects of innovative technologies. Lastly, we present ethical and clinical perspectives related to frailty in oncological patients and emerging difficulties in sustainable socio-economical governance.