增效与减毒:局部晚期鼻咽癌的治疗进展  

Enhancing Efficacy and Reducing Toxicity:Therapeutic Optimization in Locoregionally Advanced Nasopharyngeal Carcinoma

作　　者：姜薇 吕佳蔚 唐玲珑[1] 孙颖[1] 陈雨沛 马骏[1] JIANG Wei;LÜ Jiawei;TANG Linglong;SUN Ying;CHEN Yupei;MA Jun(State Key Laboratory of Oncology in South China,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy,Guangdong Provincial Clinical Research Center for Cancer,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]华南恶性肿瘤防治全国重点实验室,广东省鼻咽癌诊治研究重点实验室,广东省恶性肿瘤临床医学研究中心,中山大学肿瘤防治中心,广州510060

出　　处：《中国细胞生物学学报》2025年第3期742-756,共15页Chinese Journal of Cell Biology

基　　金：国家重点研发计划(批准号:2021YFA0909800);国家自然科学基金(批准号:82172870、81930072、82172749);广东省自然科学基金(批准号:2021B1515020010);高等学校学科创新引智计划(111计划)(批准号:B14035);中央高校基本科研业务费项目,中山大学(批准号:22ykqb14)资助的课题。

摘　　要：调强放射治疗(intensity-modulated radiation therapy,IMRT)作为鼻咽癌(nasopharyngeal carcinoma,NPC)的根本治疗方式,可显著提高肿瘤的局部控制率。然而,远处转移仍是治疗失败的主要原因。近年来,多项大型临床试验证实,化疗结合IMRT可提高高危局部晚期鼻咽癌患者的生存率,其中,诱导化疗和节拍辅助化疗以其确切的增效作用和良好的患者耐受性已成为目前指南推荐的首选治疗模式。此外,随着患者生存期的延长,保证其生活质量尤为重要。在鼻咽癌减毒治疗方面,化疗豁免、选用低毒等效化疗药物以及选择性豁免低危淋巴结区域预防性放疗等治疗策略能够在维持疗效的同时,显著提高患者的生活质量。免疫治疗近期已成为局部晚期鼻咽癌治疗的研究热点,显示出进一步增效的能力,其与放化疗结合的最佳时机和方案仍需进一步确定。IMRT(intensity-modulated radiation therapy)has emerged as the fundamental treatment modality for NPC(nasopharyngeal carcinoma),significantly improving local control rates and patient survival.However,distant metastasis remains the primary cause of treatment failure.Recent large-scale clinical trials have demonstrated that combining systemic chemotherapy with IMRT can enhance survival rates in high-risk patients with locoregionally advanced NPC.Notably,induction chemotherapy and metronomic adjuvant chemotherapy,due to their significant efficacy and favorable patient tolerance,have become the preferred treatment regimens recommended in international guidelines.Moreover,as survival extends,maintaining patients’quality of life becomes increasingly important.Recent advancements in toxicity reduction strategies for NPC has shown enhanced patients’quality of life while preserving treatment efficacy.These strategies include chemotherapy exemptions,the adoption of lowtoxicity,equivalent chemotherapy agents,and the exemption of low-risk lymph node regions from prophylactic irradiation.Furthermore,immunotherapy has emerged as a research hotspot in the treatment of locoregionally advanced NPC,demonstrating its ability to enhance treatment outcomes.Further research is needed to determine the optimal timing and regimen for its integration with chemoradiotherapy.

关 键 词：鼻咽癌 诱导化疗 节拍化疗 免疫抑制剂 选择性照射 

分 类 号：R73[医药卫生—肿瘤]