Radiotherapy (RT) is an integral component in the multidisciplinary management of patients with head and neck squamous cell carcinoma (HNSCC). Significant advances have been made toward optimizing tumor control and toxicity profiles of RT for HNSCC in the past two decades. The development of intensity modulated radiotherapy (IMRT) and concurrent chemotherapy established the standard of care for most patients with locally advanced HNSCC around the turn of the century. More recently, selective dose escalation to the most radioresistant part of tumor and avoidance of the most critical substructures of organs at risk, often guided by functional imaging, allowed even further improvement in the therapeutic ratio of IMRT. Other highly conformal RT modalities, including intensity modulated proton therapy (IMPT) and stereotactic body radiotherapy (SBRT) are being increasingly utilized, although there are gaps in our understanding of the normal tissue complication probabilities and their relative biological effectiveness. There is renewed interest in spatially fractionated radiotherapy (SFRT), such as GRID and LATTICE radiotherapy, in both palliative and definitive settings. The emergence of immune checkpoint inhibitors (ICIs) has revolutionized the treatment of patients with recurrent and metastatic HNSCC. Novel RT modalities, including IMPT, SBRT, and SFRT, have the potential to reduce lymphopenia and immune suppression, stimulate anti-tumor immunity, and synergize with ICIs. The next frontier in the treatment of HNSCC may lie in the exploration of combined modality treatment with new RT technologies and ICIs.
放射治疗（RT）是头颈部鳞状细胞癌（HNSCC）患者多学科综合治疗的重要组成部分。过去二十年来，在优化HNSCC放疗的肿瘤控制和毒性特征方面取得了显著进展。调强放射治疗（IMRT）的发展及同步化疗的应用，在世纪之交为大多数局部晚期HNSCC患者确立了标准治疗方案。近年来，通过功能影像引导对肿瘤最耐放射区域进行选择性剂量提升，同时避开危及器官的关键亚结构，使得IMRT的治疗比得到进一步提升。其他高适形放疗技术，包括调强质子治疗（IMPT）和立体定向体部放疗（SBRT）的应用日益广泛，尽管我们对正常组织并发症概率及其相对生物效应的理解仍存在不足。空间分割放疗（SFRT），如网格放疗和晶格放疗，在姑息性和根治性治疗中重新受到关注。免疫检查点抑制剂（ICIs）的出现彻底改变了复发性和转移性HNSCC的治疗模式。新型放疗技术（包括IMPT、SBRT和SFRT）具有减少淋巴细胞减少和免疫抑制、刺激抗肿瘤免疫以及与ICIs协同作用的潜力。HNSCC治疗的下一前沿领域可能在于探索新型放疗技术与ICIs的联合治疗模式。
肿瘤(癌症)患者之家