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头颈癌
Head and Neck Cancer


Laura Q.M. Chow ... 肿瘤 • 2020.01.02

虽然头颈癌可出现疼痛、毁容、功能障碍、社会心理应激和死亡,但最近的研究进展已带来了结局的显著改善。采用免疫检查点抑制剂治疗复发性或转移性头颈癌对一些患者有显著益处。与此同时,标准疗法(如保留器官的微创手术方法,放疗的进步和多模式治愈性疗法)的改进已经可以更好地保留功能,并减少疾病和死亡。我们对人乳头瘤病毒(HPV)相关口咽癌的认识和诊断不断增加,同时与烟草相关的头颈癌不断减少,这些同样改变了我们对头颈癌的认识,以及头颈癌的治疗和患者预后。

 

定义


根据流行病学因素、解剖位置和分期,头颈癌患者的预后和多模式治疗方案各不相同。起源于头部和颈部的肿瘤有明显的异质性(图1)。本文讨论的重点是起源于口腔、鼻腔、咽部和喉部四个主要解剖部位黏膜表面的鳞状细胞癌(由于在流行病学、病理学、自然史和治疗方法方面存在超出本综述范围的差异,故未对鼻咽癌进行讨论)。





作者信息

Laura Q.M. Chow, M.D.
From the Division of Medical Oncology, Department of Medicine, University of Washington, Thoracic, Head, and Neck Malignancies, Seattle Cancer Care Alliance, and Fred Hutchinson Cancer Research Center — all in Seattle. Address reprint requests to Dr. Chow at the University of Texas at Austin, Dell Medical School, 1701 Trinity St., Stop Z1100, Austin, TX 78712, or at laura.chow@austin.utexas.edu.

 

参考文献

1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.

2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018;68:7-30.

3. Mourad M, Jetmore T, Jategaonkar AA, Moubayed S, Moshier E, Urken ML. Epidemiological trends of head and neck cancer in the United States: a SEER population study. J Oral Maxillofac Surg 2017;75:2562-2572.

4. Global Burden of Disease Cancer Collaboration. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol 2017;3:524-548.

5. Gillison ML, Chaturvedi AK, Anderson WF, Fakhry C. Epidemiology of human papillomavirus-positive head and neck squamous cell carcinoma. J Clin Oncol 2015;33:3235-3242.

6. Chaturvedi AK, Engels EA, Pfeiffer RM, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol 2011;29:4294-4301.

7. Tandon S, Shahab R, Benton JI, Ghosh SK, Sheard J, Jones TM. Fine-needle aspiration cytology in a regional head and neck cancer center: comparison with a systematic review and meta-analysis. Head Neck 2008;30:1246-1252.

8. Adoga AA, Silas OA, Nimkur TL. Open cervical lymph node biopsy for head and neck cancers: any benefit? Head Neck Oncol 2009;1:9-9.

9. Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 2017;67:93-99

10. D’Souza G, Westra WH, Wang SJ, et al. Differences in the prevalence of human papillomavirus (HPV) in head and neck squamous cell cancers by sex, race, anatomic tumor site, and HPV detection method. JAMA Oncol 2017;3:169-177.

11. Seiwert TY, Haddad R, Bauml J, et al. Biomarkers predictive of response to pembrolizumab in head and neck cancer (HNSCC). Cancer Res 2018;78:LB-339-LB-339. abstract.

12. Nguyen-Tan PF, Zhang Q, Ang KK, et al. Randomized phase III trial to test accelerated versus standard fractionation in combination with concurrent cisplatin for head and neck carcinomas in the Radiation Therapy Oncology Group 0129 trial: long-term report of efficacy and toxicity. J Clin Oncol 2014;32:3858-3866.

13. Lydiatt WM, Patel SG, O’Sullivan B, et al. Head and neck cancers: major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 2017;67:122-137.

14. O’Sullivan B, Huang SH, Su J, et al. Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal Cancer Network for Staging (ICON-S): a multicentre cohort study. Lancet Oncol 2016;17:440-451.

15. Porceddu SV, Milne R, Brown E, et al. Validation of the ICON-S staging for HPV-associated oropharyngeal carcinoma using a pre-defined treatment policy. Oral Oncol 2017;66:81-86.

16. Eskander A, Irish J, Groome PA, et al. Volume-outcome relationships for head and neck cancer surgery in a universal health care system. Laryngoscope 2014;124:2081-2088.

17. Vokes EE, Agrawal N, Seiwert TY. HPV-associated head and neck cancer. J Natl Cancer Inst 2015;107(12):djv344-djv344.

18. Cheraghlou S, Yu PK, Otremba MD, et al. Treatment deintensification in human papillomavirus-positive oropharynx cancer: outcomes from the National Cancer Data Base. Cancer 2018;124:717-726.

19. Ang KK, Harris J, Wheeler R, et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 2010;363:24-35.

20. Moore EJ, Hinni ML. Critical review: transoral laser microsurgery and robotic-assisted surgery for oropharynx cancer including human papillomavirus-related cancer. Int J Radiat Oncol Biol Phys 2013;85:1163-1167.

21. Haughey BH, Hinni ML, Salassa JR, et al. Transoral laser microsurgery as primary treatment for advanced-stage oropharyngeal cancer: a United States multicenter study. Head Neck 2011;33:1683-1694.

22. Marur S, Li S, Cmelak AJ, et al. E1308: phase II trial of induction chemotherapy followed by reduced-dose radiation and weekly cetuximab in patients with HPV-associated resectable squamous cell carcinoma of the oropharynx. J Clin Oncol 2017;35:490-497.

23. Seiwert TY, Foster CC, Blair EA, et al. OPTIMA: a phase II dose and volume de-escalation trial for human papillomavirus-positive oropharyngeal cancer. Ann Oncol 2019;30:297-302.

24. Pfister DG, Spencer S, Brizel DM, et al. Head and neck cancers, version 2.2014: clinical practice guidelines in oncology. J Natl Compr Canc Netw 2014;12:1454-1487.

25. Moore EJ, Janus J, Kasperbauer J. Transoral robotic surgery of the oropharynx: clinical and anatomic considerations. Clin Anat 2012;25:135-141.

26. Weiss BG, Ihler F, Wolff HA, et al. Transoral laser microsurgery for treatment for hypopharyngeal cancer in 211 patients. Head Neck 2017;39:1631-1638.

27. Gupta T, Kannan S, Ghosh-Laskar S, Agarwal JP. Systematic review and meta-analyses of intensity-modulated radiation therapy versus conventional two-dimensional and/or three-dimensional radiotherapy in curative-intent management of head and neck squamous cell carcinoma. PLoS One 2018;13(7):e0200137-e0200137.

28. Adelstein D, Gillison ML, Pfister DG, et al. NCCN guidelines insights: head and neck cancers, version 2.2017. J Natl Compr Canc Netw 2017;15:761-770.

29. D’Cruz AK, Vaish R, Kapre N, et al. Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med 2015;373:521-529.

30. Worden FP, Ha H. Controversies in the management of oropharynx cancer. J Natl Compr Canc Netw 2008;6:707-714.

31. Braakhuis BJ, Brakenhoff RH, Leemans CR. Treatment choice for locally advanced head and neck cancers on the basis of risk factors: biological risk factors. Ann Oncol 2012;23:Suppl 10:x173-x177.

32. Brana I, Siu LL. Locally advanced head and neck squamous cell cancer: treatment choice based on risk factors and optimizing drug prescription. Ann Oncol 2012;23:Suppl 10:x178-x185.

33. Pignon JP, le Maître A, Maillard E, Bourhis J. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009;92:4-14.

34. Blanchard P, Landais C, Petit C, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 100 randomized trials and 19,248 patients, on behalf of MACH-NC group Ann Oncol 2016;27:Suppl 6:vi328-vi350.

35. Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 2013;31:845-852.

36. Blanchard P, Baujat B, Holostenco V, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): a comprehensive analysis by tumour site. Radiother Oncol 2011;100:33-40.

37. Leemans CR, Tiwari R, van der Waal I, Karim AB, Nauta JJ, Snow GB. The efficacy of comprehensive neck dissection with or without postoperative radiotherapy in nodal metastases of squamous cell carcinoma of the upper respiratory and digestive tracts. Laryngoscope 1990;100:1194-1198.

38. Adelstein DJ, Li Y, Adams GL, et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 2003;21:92-98.

39. Bauml JM, Vinnakota R, Anna Park YH, et al. Cisplatin every 3 weeks versus weekly with definitive concurrent radiotherapy for squamous cell carcinoma of the head and neck. J Natl Cancer Inst 2019;111:490-497.

40. Noronha V, Joshi A, Patil VM, et al. Once-a-week versus once-every-3-weeks cisplatin chemoradiation for locally advanced head and neck cancer: a phase III randomized noninferiority trial. J Clin Oncol 2018;36:1064-1072.

41. Guan J, Li Q, Zhang Y, et al. A meta-analysis comparing cisplatin-based to carboplatin-based chemotherapy in moderate to advanced squamous cell carcinoma of head and neck (SCCHN). Oncotarget 2016;7:7110-7119.

42. Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006;354:567-578.

43. Mehanna H, Robinson M, Hartley A, et al. Radiotherapy plus cisplatin or cetuximab in low-risk human papillomavirus-positive oropharyngeal cancer (De-ESCALaTE HPV): an open-label randomised controlled phase 3 trial. Lancet 2019;393:51-60.

44. Gillison ML, Trotti AM, Harris J, et al. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet 2019;393:40-50.

45. Lacas B, Bourhis J, Overgaard J, et al. Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis. Lancet Oncol 2017;18:1221-1237.

46. Bourhis J, Sire C, Graff P, et al. Concomitant chemoradiotherapy versus acceleration of radiotherapy with or without concomitant chemotherapy in locally advanced head and neck carcinoma (GORTEC 99-02): an open-label phase 3 randomised trial. Lancet Oncol 2012;13:145-153.

47. Ang KK, Zhang Q, Rosenthal DI, et al. Randomized phase III trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III to IV head and neck carcinoma: RTOG 0522. J Clin Oncol 2014;32:2940-2950.

48. Blanchard P, Gunn GB, Lin A, Foote RL, Lee NY, Frank SJ. Proton therapy for head and neck cancers. Semin Radiat Oncol 2018;28:53-63.

49. Hitt R, López-Pousa A, Martínez-Trufero J, et al. Phase III study comparing cisplatin plus fluorouracil to paclitaxel, cisplatin, and fluorouracil induction chemotherapy followed by chemoradiotherapy in locally advanced head and neck cancer. J Clin Oncol 2005;23:8636-8645.

50. Posner MR, Hershock DM, Blajman CR, et al. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 2007;357:1705-1715.

51. Vermorken JB, Mesia R, Rivera F, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med 2008;359:1116-1127.

52. Cohen EE, Vokes EE. Induction chemotherapy and radiotherapy in locally advanced non-small cell lung cancer. Hematol Oncol Clin North Am 2004;18:81-90.

53. Haddad R, O’Neill A, Rabinowits G, et al. Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol 2013;14:257-264.

54. Haddad RI, Posner M, Hitt R, et al. Induction chemotherapy in locally advanced squamous cell carcinoma of the head and neck: role, controversy, and future directions. Ann Oncol 2018;29:1130-1140.

55. Blanchard P, Bourhis J, Lacas B, et al. Taxane-cisplatin-fluorouracil as induction chemotherapy in locally advanced head and neck cancers: an individual patient data meta-analysis of the meta-analysis of chemotherapy in head and neck cancer group. J Clin Oncol 2013;31:2854-2860.

56. Lorch JH, Posner MR, Wirth LJ, Haddad RI. Induction chemotherapy in locally advanced head and neck cancer: a new standard of care? Hematol Oncol Clin North Am 2008;22:1155-1163.

57. Bernier J, Cooper JS, Pajak TF, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005;27:843-850.

58. Bernier J, Domenge C, Ozsahin M, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004;350:1945-1952.

59. Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004;350:1937-1944.

60. Cooper JS, Zhang Q, Pajak TF, et al. Long-term follow-up of the RTOG 9501/intergroup phase III trial: postoperative concurrent radiation therapy and chemotherapy in high-risk squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2012;84:1198-1205.

61. Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet 2008;371:1695-1709.

62. Lefebvre J-L. Current clinical outcomes demand new treatment options for SCCHN. Ann Oncol 2005;16:Suppl 6:vi7-vi12.

63. Vermorken JB, Herbst RS, Leon X, Amellal N, Baselga J. Overview of the efficacy of cetuximab in recurrent and/or metastatic squamous cell carcinoma of the head and neck in patients who previously failed platinum-based therapies. Cancer 2008;112:2710-2719.

64. Chow LQM, Haddad R, Gupta S, et al. Antitumor activity of pembrolizumab in biomarker-unselected patients with recurrent and/or metastatic head and neck squamous cell carcinoma: results from the phase Ib KEYNOTE-012 expansion cohort. J Clin Oncol 2016;34:3838-3845.

65. Larkins E, Blumenthal GM, Yuan W, et al. FDA Approval Summary: Pembrolizumab for the Treatment of Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma with Disease Progression on or After Platinum-Containing Chemotherapy. Oncologist 2017;22:873-878.

66. Seiwert TY, Burtness B, Mehra R, et al. Safety and clinical activity of pembrolizumab for treatment of recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-012): an open-label, multicentre, phase 1b trial. Lancet Oncol 2016;17:956-965.

67. Mehra R, Seiwert TY, Gupta S, et al. Efficacy and safety of pembrolizumab in recurrent/metastatic head and neck squamous cell carcinoma: pooled analyses after long-term follow-up in KEYNOTE-012. Br J Cancer 2018;119:153-159.

68. Bauml J, Seiwert TY, Pfister DG, et al. Pembrolizumab for platinum- and cetuximab-refractory head and neck cancer: results from a single-arm, phase II study. J Clin Oncol 2017;35:1542-1549.

69. Cohen EEW, Soulières D, Le Tourneau C, et al. Pembrolizumab versus methotrexate, docetaxel, or cetuximab for recurrent or metastatic head-and-neck squamous cell carcinoma (KEYNOTE-040): a randomised, open-label, phase 3 study. Lancet 2019;393:156-167.

70. Ferris RL, Blumenschein G Jr, Fayette J, et al. Nivolumab for recurrent squamous-cell carcinoma of the head and neck. N Engl J Med 2016;375:1856-1867.

71. Ferris RL, Blumenschein G Jr, Fayette J, et al. Nivolumab vs investigator’s choice in recurrent or metastatic squamous cell carcinoma of the head and neck: 2-year long-term survival update of CheckMate 141 with analyses by tumor PD-L1 expression. Oral Oncol 2018;81:45-51.

72. Chow LQM, Mehra R, Haddad RI, et al. Biomarkers and response to pembrolizumab (pembro) in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). J Clin Oncol 2016;34:15 Suppl:6010-6010. abstract.

73. FDA approves pembrolizumab for first-line treatment of head and neck squamous cell carcinoma. Food and Drug Administration June 10, 2019 (https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-first-line-treatment-head-and-neck-squamous-cell-carcinoma. opens in new tab).

74. Burtness B, Harrington KJ, Greil R, et al. Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study Lancet 2019;394:1915-1928.

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