头颈癌的大分割放疗：当前证据与未来方向，重点关注喉癌。

文献信息

中文摘要

放疗（RT）仍然是头颈部鳞状细胞癌（HNSCC）根治性和多模式治疗中的基石。虽然大分割放疗（HFRT）已成为包括前列腺癌、乳腺癌、肺癌和直肠癌在内的多种实体瘤的标准治疗，但由于头颈部解剖复杂、众多危及器官邻近以及对于严重晚期毒性的担忧，其在HNSCC中的应用更为谨慎。然而，调强放疗（IMRT）、容积旋转调强放疗（VMAT）、图像引导、自适应放疗和放射生物学理解方面的重大进展，重新激发了人们对HFRT作为保持肿瘤疗效同时缩短总治疗时间的策略的兴趣。其他驱动因素包括优化医疗资源利用、改善中低收入国家放疗可及性以及减少医院就诊的需求，这在COVID-19大流行期间尤为突出。最近的前瞻性证据进一步强化了在HNSCC中精心选择大分割方法的理由。在老年和体弱患者中，III期ELAN-RT试验也提供了关于无法接受标准治疗的患者采用定制大分割方法的前瞻性证据。在头颈部亚部位中，喉癌——尤其是早期声门癌——代表了HFRT最成熟的临床模型，因此构成本综述的主要焦点，同时检查其他HNSCC亚部位的证据以评估大分割治疗策略的更广泛适用性。本综述批判性地总结了HNSCC中根治性HFRT的放射生物学原理、当前临床证据、技术进步和持续挑战，特别强调喉癌，并讨论了其在临床实践中更广泛实施的未来方向。

英文摘要

Radiotherapy (RT) remains a cornerstone in the management of head and neck squamous cell carcinoma (HNSCC) across both definitive and multimodality treatment settings. While hypofractionated radiotherapy (HFRT) has become an established standard of care for several solid tumors, including prostate, breast, lung, and rectal cancers, its adoption in HNSCC has been more cautious owing to the complex anatomy of the head and neck region, the proximity of numerous critical organs at risk, and concerns regarding severe late toxicity. However, major advances in intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), image guidance, adaptive radiotherapy, and radiobiological understanding have renewed interest in HFRT as a strategy to maintain oncological efficacy while reducing overall treatment time. Additional drivers include the need to optimize healthcare resource utilization, improve access to radiotherapy in low- and middle-income countries, and minimize hospital visits, as highlighted during the COVID-19 pandemic. Recent prospective evidence has further strengthened the rationale for carefully selected hypofractionated approaches in HNSCC. In elderly and frail patients, the phase III ELAN-RT trial has also provided prospective evidence regarding a tailored hypofractionated approach for patients unable to undergo standard treatment. Among head and neck subsites, laryngeal cancer-particularly early-stage glottic carcinoma-represents the most mature clinical model for HFRT and therefore constitutes the principal focus of this review, while evidence from other HNSCC subsites is examined to assess the broader applicability of hypofractionated treatment strategies. This review critically summarizes the radiobiological rationale, current clinical evidence, technological advances, and ongoing challenges surrounding radical HFRT in HNSCC, with particular emphasis on laryngeal cancer, and discusses future directions for its broader implementation in clinical practice.