局部晚期头颈部癌症也可治愈!微创手术、质子、免疫、光免疫疗法提高治愈可能!

2022-08-10 厚朴方舟 厚朴方舟

研究结果显示,同步治疗组和序贯治疗组的效果均十分显著。

与其他部位的肿瘤相比,头颈部癌症虽然发病率不高,但由于解剖部位复杂、器官密集、病种多,尤其是对于局部晚期头颈部癌症,单一的治疗方式无法满足头颈部癌症治疗的需求,需要综合手术、放疗、化疗、免疫治疗在内的多种治疗手段。近年来,随着医疗技术的不断发展,头颈部癌症的治疗手段越来越多,即使是局部晚期头颈部癌症也有治愈可能。

1.微创手术

与其他部位肿瘤相比,头颈部癌症的治疗需要在根治疾病同时兼顾保留功能与外观,因此多以保留功能手术为主,辅助其他治疗手段。同时头颈部癌症的治疗十分要求手术的精细度,部分患者术后还需要合并立即修复组织缺损的手术。

2020年发表的一项研究针对局部晚期头颈部鳞状细胞癌的治疗策略和结果进行了分析评估。研究共纳入445名头颈部鳞状细胞癌患者,结果显示,通过手术为主的综合治疗后,头颈部癌症患者的1年生存率为88.7%;2年生存率为79.8%[1]。

▲图源:参考来源[1]

另一方面,随着外科技术的不断发展,经口外科手术(TOS)的出现为头颈部癌症患者提供了新的治疗选择。

2022年发布的一项研究(ECOG 3311)评估了经口外科手术(TOS)联合术后辅助治疗治疗局部晚期口腔癌的效果。研究人员根据患者的风险进行了分级:A组(低风险)、B组(中风险,术后放疗剂量为50Gy)、C组(中风险,术后放疗剂量为60Gy)、D组(高风险)。研究结果显示,采用手术联合辅助治疗后A组的2年无进展生存率为96.9%,B组为94.9%,C组为96%,D组为90.7%。证实,针对局部晚期口腔癌根据风险分级采用经口外科手术(TOS)联合辅助治疗的效果显著。

▲图源:参考来源[2]

另一方面,达芬奇机器人手术系统的出现,也为头颈部癌症患者的治疗提供了新的选择。达芬奇机器人手术拥有三维影像技术,可以向术者提供高清晰的三维影像,突破了人眼的极限,并且能够将手术部位放大10-15倍,使手术的效果更加精准。同时,达芬奇手术机器人的机器手臂非常灵活,而且具有无法比拟的稳定性及精确度,能够完成各类高难度的精细手术。

2.质子治疗

质子治疗作为一种新兴的放疗技术,可以将照射剂量的大部分沉积在高度集中的区域内,从而减少放疗对邻近危及器官和正常组织的辐射暴露,减少与治疗相关的毒性反应并改善患者生活质量。目前,质子治疗可以作为局部晚期头颈部癌症根治性疗法、术后辅助疗法以及复发后的再次治疗,提高患者的预后。

2021年6月25日,发表在《International Journal of Particle Therapy》杂志中的研究,针对质子治疗头颈部癌症的12年调查结果进行了分析。研究将采用质子治疗的头颈部癌症患者分为根治性质子治疗组、术后质子治疗组和再次放疗组三组,结果显示,根治性质子治疗组的2年和5年生存率分别是91%和78%,术后质子治疗的2年和5年生存率为89%和77%,再次放疗的生存率为63%和52%。

▲图源:参考来源[3]

3.免疫联合放化疗

2022年美国临床肿瘤学会(ASCO)中,一项探究在放化疗(CRT)的基础上同步或序贯帕博利珠单抗治疗初治局部晚期头颈部癌症患者的疗效的研究结果以口头报告形式重磅发布,为局部晚期头颈部癌症的治疗提供了新思路。

研究兑现给中危HPV阳性局部晚期头颈部鳞状细胞癌患者和HPV阴性的初治口咽部/下咽部/喉部/口腔局部晚期头颈部鳞状细胞癌患者,入组后患者接受CRT(顺铂40 mg/m 2每周+35次70 Gy放射治疗)+同步或序贯帕博利珠单抗治疗

研究结果显示,同步治疗组和序贯治疗组的效果均十分显著,其中同步治疗组1、2、3年无进展生存率分别为82%、78%、74%,1、2、3年生存率率同样分别为82%、78%、74%;序贯治疗组1、2、3年无进展生存率分别为89%、89%、84%,1、2、3年生存率分别为95%、95%、90%[4]。

▲图源:参考来源[4]

4.光免疫疗法

2020年9月日本厚生劳动省批准全球首个光免疫疗法药物Akalux,用于手术无法切除的局部晚期头颈部恶性肿瘤。临床试验的结果显示Akalux缓解率为43.3%(完全缓解13.3%,部分缓解30.0%)。在日本国内Ⅰ期临床试验中,Akalux的缓解率高达66.7%,效果显著!

参考来源:

[1]Treatment strategy and outcomes in locally advanced head and neck squamous cell carcinoma: a nationwide retrospective cohort study (KCSG HN13–01) | BMC Cancer | Full Text

https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-07297-z

[2]Ferris RL, Flamand Y, Weinstein GS, Li S, Quon H, Mehra R, Garcia JJ, Chung CH, Gillison ML, Duvvuri U, O'Malley BW Jr, Ozer E, Thomas GR, Koch WM, Gross ND, Bell RB, Saba NF, Lango M, Méndez E, Burtness B. Phase II Randomized Trial of Transoral Surgery and Low-Dose Intensity Modulated Radiation Therapy in Resectable p16+ Locally Advanced Oropharynx Cancer: An ECOG-ACRIN Cancer Research Group Trial (E3311). J Clin Oncol. 2022 Jan 10;40(2):138-149. doi: 10.1200/JCO.21.01752. Epub 2021 Oct 26. PMID: 34699271; PMCID: PMC8718241.

[3] Gunn GB, Garden AS, Ye R, Ausat N, Dahlstrom KR, Morrison WH, Fuller CD, Phan J, Reddy JP, Shah SJ, Mayo LL, Chun SG, Chronowski GM, Moreno AC, Myers JN, Hanna EY, Esmaeli B, Gillison ML, Ferrarotto R, Hutcheson KA, Chambers MS, Ginsberg LE, El-Naggar AK, Rosenthal DI, Zhu XR, Frank SJ. Proton Therapy for Head and Neck Cancer: A 12-Year, Single-Institution Experience. Int J Part Ther. 2021 Jun 25;8(1):108-118. doi: 10.14338/IJPT-20-00065.1. PMID: 34285940; PMCID: PMC8270083

[4]Protocol specified final results of the KEYNOTE048 Trial of Pembrolizumab as first line therapy for tecurrent/metastatic Head and Neck Squamous Cell Carcinoma,ASCO 2019.Abs 6000.

[5]Clump DA,et al.ASCO 2022.Abs 6007.

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    2022-08-12 vera_1203
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    2022-08-12 chg122
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