老年局部晚期头颈部鳞癌非手术治疗研究进展

Review on non-surgical treatment for elderly patients with locally advanced head and neck squamous cell carcinoma

随着人口老龄化,老年(≥65岁)肿瘤患者已经成为临床主体患者人群之一。对于无法手术的局部晚期头颈部鳞癌,以顺铂为基础的同步放化疗是一线治疗方案。多个大型临床研究表明,<70岁患者可以从同步放化疗中获益,70~80岁的患者存在争议,选择化疗时需慎重。对于顺铂不能耐受的老年患者,可以选用卡铂或尝试其他消化道及肾不良反应较小的化疗方案。西妥昔单抗等抗表皮生长因子受体(EGFR)单抗联合放疗尽管在整体人群中优于单纯放疗,但年龄亚组分析显示老年患者获益有限。新兴的免疫检查点抑制剂在老年患者中的安全性已得到证实,程序性死亡蛋白配体-1(PD-L1)高表达的老年患者可能从同步放疗或新辅助治疗中获益,但相关的高级别临床证据仍然缺乏。对于>80岁的高龄患者,单纯放疗可能优于同步放化疗,以姑息治疗为目的的低分割/大分割放疗可安全用于这部分人群。

With the aging of population,the elderly(≥65 years old)cancer patients have become one of the main populations for cancer care.For inoperable locally advanced head and neck squamous carcinomas,cisplatin-based concurrent chemoradiotherapy is the first-line choice.Several large clinical studies have shown that patients under 70 years of age can still benefit from concurrent chemoradiotherapy,while it should be cautious to apply chemotherapy to patients aged 70-80 years.For elderly patients who are intolerant to cisplatin,carboplatin or other regimens with less gastrointestinal and renal toxicity should be considered.Although anti-epidermal growth factor receptor(EGFR)monoclonal antibodies combined with radiotherapy has been proved to be more effective than radiotherapy alone in total patient population,age-subgroup analysis showed limited benefit in elderly patients.The safety of immune checkpoint inhibitors in elderly patients has been validated and those with high programmed death ligand-1(PD-L1)expression may benefit from concurrent or neoadjuvant immunotherapy,however,high-level evidence is still lacking.For patients older than 80 years,radiotherapy alone may be superior to concurrent chemoradiotherapy,and hypofractionated radiotherapy for palliative purposes can be safely used in this population.