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初诊转移性鼻咽癌的根治性治疗:国际肿瘤协作组织循证共识指南

Curative-intent management of de novo metastatic nasopharyngeal carcinoma: an evidence-based consensus guideline from the International Collaborating Oncology Organisations.

指南共识鼻咽癌IF 40.5Q1

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中文摘要

背景: 初诊转移性鼻咽癌患者历史上被认为不可治愈,并以姑息性治疗为目的。强效全身治疗联合针对局部区域和转移性疾病的局部治疗的出现,使部分患者获得长期生存。方法:本国际指南由来自18个国家或地区46个中心的54名专家通过共识构建制定,并得到17个肿瘤组织的认可。结果:在七个临床领域共形成32条推荐意见,包括29条强推荐(≥80%同意[共识]或高质量证据)和3条有条件推荐(67-79%同意)。我们推荐,对于基线时或全身治疗反应后转移病灶不超过三个且累及不超过两个器官的医学上适合的患者,应提供根治性治疗;推荐多模式治疗(包括免疫化疗、局部区域放疗、转移灶导向治疗和维持治疗)。结论:本指南为初诊转移性鼻咽癌临床管理的标准化提供了实用框架,并确定了未来研究的关键证据空白。

英文摘要

Patients with de novo metastatic nasopharyngeal carcinoma were historically deemed incurable and treated with palliative intent. Emergence of potent systemic therapy in combination with local treatment for both locoregional and metastatic diseases has enabled long-term survival in some patients. This international guideline was developed through consensus-building by 54 experts from 46 centres across 18 countries or regions and endorsed by 17 oncology organisations. 32 recommendations across seven clinical domains were formulated, including 29 strong (≥80% agreement [consensus] or high quality of evidence) and three conditional recommendations (67-79% agreement). We recommend that curative-intent treatment should be offered to medically fit patients with no more than three metastatic lesions in two or fewer organs at baseline or following response to systemic therapy; multimodality treatment (comprising immunochemotherapy, locoregional radiotherapy, metastasis-directed therapy, and maintenance therapy) is recommended. This guideline provides a practical framework for standardisation of clinical management of de novo metastatic nasopharyngeal carcinoma and identification of key evidence gaps for future research.