头颈鳞癌根治性手术后辅助治疗

Adjuvant treatment for squamous cell carcinoma of head and neck after definitive surgery

头颈部鳞癌根治术后的辅助治疗在整个治疗中占有重要地位。早期N+患者可接受根治手术后的辅助放疗;同步放化疗则是局部晚期头颈鳞癌患者术后辅助的标准治疗模式。联合治疗能有效提高肿瘤的局部控制率和患者的无病生存率及总生存率,但联合治疗所导致的急慢性不良反应亦不容忽视。调强放射治疗(intensity modulated radiation therapy,IMRT)较三维适型放疗更为精确和适形,但是否可能增加治疗后局部区域复发风险仍需进一步研究。分子靶向治疗(如西妥昔单抗、尼妥珠单抗)联合放射治疗虽可提高局部晚期头颈部鳞癌根治后的疗效,但其联合放疗的治疗策略在术后辅助治疗上的应用,尚无设计良好的临床研究结果的支持。人乳头状瘤病毒(human papillomavirus,HPV)与头颈部鳞癌的预后及治疗的相关性,及其对治疗选择的指导作用,则有待进一步研究。

Adjuvant treatment after definitive surgery is an integral part of the management of locoregionally advanced squamous cell carcinoma of the head and neck （HNSCC）. Earlier stage HNSCC with N. disease may require adjuvant radiotherapy, while locoregionally advanced disease requires postoperative chemoradiation therapy for eradicating subclinical residual disease. Tri-modality with surgery followed by concurrent chemoradiation can improve the local control, disease free survival, and overa｜l surviva｜ rates in patients with advanced HNSCC as compare to surgery or surgery plus radiation. However, treatment induced adverse-effects should be addressed when deciding on the treatment options. Molecular targeted therapy is a new treatment modality and its efficacy when used in concurrentwith radiation as a definitive treatment has been suggested. However, adjuvant use of radiation and targeted therapy requires further investigation before it can be recommended routinely in clinical practice. The association between HPV and HNSCC, as well as the clinical implication of such association require further study as well.