局部晚期头颈部鳞状细胞癌新辅助治疗的进展（综述）

文献信息

中文摘要

背景： 大多数头颈部癌症起源于口腔、咽和喉的黏膜鳞状上皮，统称为头颈部鳞状细胞癌（HNSCC）。病例管理采用多学科标准治疗。原发性口腔癌采用切除术继以顺铂为基础的辅助放化疗（CRT），而咽部或喉部疾病采用根治性同步CRT。在医学上不适合铂类治疗的人乳头瘤病毒阴性患者中，表皮生长因子受体导向的单克隆抗体西妥昔单抗与放疗（RT）同时给药。最近，免疫检查点抑制剂（ICI）重新定义了复发/转移性HNSCC的系统治疗，产生了持久缓解和生存获益。总共有65-70%的患者表现为III-IVA期局部晚期（LA）疾病，这种情况与治疗挑战和生活质量显著恶化相关。新辅助治疗旨在降期原发肿瘤、根除隐匿性微转移疾病并在根治性手术或RT前增强局部区域控制，从而为器官保留提供合理策略。当代方案将紫杉烷、铂类和5-氟尿嘧啶诱导化疗与RT整合，早期试验探索了将ICI纳入新辅助方案的可行性和疗效。本综述总结了LA HNSCC新辅助治疗的演变，特别强调新兴的基于免疫治疗的范式及其改善肿瘤学和功能结局的潜力。

英文摘要

The majority of head and neck cancers arise from the mucosal squamous epithelium of the oral cavity, pharynx and larynx, and are collectively referred to as head and neck squamous cell carcinoma (HNSCC). A multimodal standard of care is applied for case management. Primary oral cavity cancers are treated with resection followed by adjuvant cisplatin‑based chemoradiotherapy (CRT), and definitive concurrent CRT is applied for pharyngeal or laryngeal disease. In human papillomavirus‑negative patients who are medically unfit for platinum treatment, the epidermal growth factor receptor‑directed monoclonal antibody cetuximab is administered concomitantly with radiotherapy (RT). More recently, immune checkpoint inhibitors (ICIs) have redefined systemic therapy for recurrent/metastatic HNSCC, yielding durable responses and a survival benefit. In total, 65‑70% of patients present with stage III‑IVA locally advanced (LA) disease, a scenario associated with therapeutic challenges and a marked deterioration in the quality of life. Neoadjuvant therapy is designed to downstage the primary tumor, eradicate occult micrometastatic disease and enhance locoregional control before definitive surgery or RT, thus offering a rational strategy for organ preservation. Contemporary regimens integrate taxane, platinum and 5‑fluorouracil induction chemotherapy with RT, and early‑phase trials have explored the feasibility and efficacy of incorporating ICIs into neoadjuvant protocols. The present review summarizes the evolution of neoadjuvant therapy for LA HNSCC, with particular emphasis on emerging immunotherapy‑based paradigms and their potential to improve oncological and functional outcomes.