放疗在头颈部晚期肿瘤器官功能保全治疗中的作用

The role of radiotherapy in the organ-preservation therapy for locally advanced head and neck cancers

器官功能保全治疗在头颈部肿瘤病人的治疗中有非常重要的地位。目前头颈部晚期肿瘤的非手术治疗方法主要有放射治疗和化疗联合放射治疗。超分割治疗和加速超分割治疗与常规放射治疗比较,能够提高局部控制率和器官功能保全率。诱导化疗加放疗能够使约60％的喉癌患者保留喉功能,与常规放射治疗比较,不能提高生存率。同步放化疗显著提高器官功能保全率,是目前器官功能保全性非手术治疗的主要治疗方案,同步放化疗与非常规分割方式结合能否经一步提高器官功能保全率仍需要进一步研究。一些新的方法如新药及不同给药方式,调强放射治疗,分子靶向治疗,乏氧增敏剂等在头颈肿瘤治疗中的作用的试验正在进行中。

Organ-preservation plays an important role in the treatment of locally advanced head and neck cancers. Radiotherapy and the combination of radiation and chemotherapy are two mainstay non-surgical means in the treatment of these patients. It has been demonstrated that hyperfactionation radiotherapy and accelerated hyper-fractionation can improve the outcome as compared to the conventional radiotherapy. Induction chemotherapy plus radiotherapy may result in laryngeal reservation in about 60% patients with locally advanced pharyngeal cancer. Concurrent chemoradiotherapy improved the organ-preservation rate significantly than radiotherapy alone, and it was considered as a standard care of laryngeal reservation in these patients. Salvage therapy with laryngectomy was only performed for relapsed patients after chemoradiotherapy. With regard to accelerated radiotherapy , the efficiency of simultaneously given chemotherapy may be not as high as expected when compared to standard fractionated radiotherapy, its efficiency needs further investigation. Some new strategies aimed to improve the treatment result such as finding more effective drug and delivery way; intensity-modulation radiotherapy , molecular targeted therapy and hypoxia cell sensitizer combined with radiotherapy and chemoradiotherapy are ongoing.