鼻咽癌治疗的综述！
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Optimal management of nasopharyngeal carcinoma
[Head and neck]
Faivre, Sandrinea,b; Janot,
Abstract
Purpose of review: Given the high rate of mortality still associated with advanced stages of nasopharyngeal carcinoma, this review focuses on some specific aspects of this potentially curable disease that could translate into improved therapeutic approaches.
Recent findings: Epstein–Barr viral-induced carcinogenesis is almost constantly reported in the undifferentiated type of nasopharyngeal carcinoma. Nasopharyngeal carcinoma retains clonal characteristics and p53 functionality up to late stages that may account for its high level of chemo- and radiotherapy sensitivity, with several cases of long-term survivors reported among patients with bone metastasis. Recent imaging and biologic techniques will help to identify patients at risk of distant failures (detection of plasma Epstein–Barr virus DNA) or those harboring posttherapeutic residual diseases (positron emission tomographic scan). Cisplatin-based induction chemotherapy has shown disease-free survival benefit, whereas concomitant chemoradiotherapy is associated with an improved local–regional control. Late radiation-induced toxicities (especially xerostomia) will hopefully be reduced using intensity-modulated radiation therapy. New therapeutic agents such as taxanes, or targeted therapies (epidermal growth factor receptor inhibitors) are of major interest in the challenge of circumventing resistance to alkylating agents.
Summary: Better knowledge of nasopharyngeal carcinoma pathogenesis and biology, management of patients in highly specialized oncologic units, and careful selection of cytotoxic agents along with multimodality integrated therapeutic programs will likely yield to improved survival, particularly for patients with locally advanced nasopharyngeal carcinoma.
。。。。。。。
CONCLUSION
The identification of factors that can predict local–regional or distant failures remains of major interest to define subgroups of patients and to tailor their treatment according to an accurate staging of the disease. The high rate of distant metastasis in node-positive patients stresses the need for induction systemic therapy. The use of systemic chemotherapy in a neoadjuvant setting for patients with good performance status appears to be well tolerated, allowing one to achieve an optimal dose intensity. Highly active regimens, delivered under the responsibility of a medical oncologist and eventually including new cytotoxic compounds such as taxanes may contribute to circumvent some of the alkylating agent-induced acquired resistance. In addition, cisplatin-based concomitant chemoradiotherapy has shown consistent reduction in the rate of local–regional failures. Far from being mutually exclusive, we think that induction dose-dense chemotherapy followed by concomitant chemoradiotherapy could further help to improve the survival of locally advanced NPC.
[Head and neck]
Faivre, Sandrinea,b; Janot,
Abstract
Purpose of review: Given the high rate of mortality still associated with advanced stages of nasopharyngeal carcinoma, this review focuses on some specific aspects of this potentially curable disease that could translate into improved therapeutic approaches.
Recent findings: Epstein–Barr viral-induced carcinogenesis is almost constantly reported in the undifferentiated type of nasopharyngeal carcinoma. Nasopharyngeal carcinoma retains clonal characteristics and p53 functionality up to late stages that may account for its high level of chemo- and radiotherapy sensitivity, with several cases of long-term survivors reported among patients with bone metastasis. Recent imaging and biologic techniques will help to identify patients at risk of distant failures (detection of plasma Epstein–Barr virus DNA) or those harboring posttherapeutic residual diseases (positron emission tomographic scan). Cisplatin-based induction chemotherapy has shown disease-free survival benefit, whereas concomitant chemoradiotherapy is associated with an improved local–regional control. Late radiation-induced toxicities (especially xerostomia) will hopefully be reduced using intensity-modulated radiation therapy. New therapeutic agents such as taxanes, or targeted therapies (epidermal growth factor receptor inhibitors) are of major interest in the challenge of circumventing resistance to alkylating agents.
Summary: Better knowledge of nasopharyngeal carcinoma pathogenesis and biology, management of patients in highly specialized oncologic units, and careful selection of cytotoxic agents along with multimodality integrated therapeutic programs will likely yield to improved survival, particularly for patients with locally advanced nasopharyngeal carcinoma.
。。。。。。。
CONCLUSION
The identification of factors that can predict local–regional or distant failures remains of major interest to define subgroups of patients and to tailor their treatment according to an accurate staging of the disease. The high rate of distant metastasis in node-positive patients stresses the need for induction systemic therapy. The use of systemic chemotherapy in a neoadjuvant setting for patients with good performance status appears to be well tolerated, allowing one to achieve an optimal dose intensity. Highly active regimens, delivered under the responsibility of a medical oncologist and eventually including new cytotoxic compounds such as taxanes may contribute to circumvent some of the alkylating agent-induced acquired resistance. In addition, cisplatin-based concomitant chemoradiotherapy has shown consistent reduction in the rate of local–regional failures. Far from being mutually exclusive, we think that induction dose-dense chemotherapy followed by concomitant chemoradiotherapy could further help to improve the survival of locally advanced NPC.
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