PDF(Pubmed)
Abstract：
Radiation therapy (RT) is a mainstay for the treatment of head and neck (HN) cancers, with 80% of patients receiving such treatment. Radiation-induced malignancies represent a life-threatening long-term effect of RT, with an incidence of 0.5% to 15%.
After 13 years, a 33-year-old woman treated with chemo-radiotherapy for nasopharyngeal carcinoma developed a locally advanced, radiation-induced, p16-negative oropharyngeal squamous cell carcinoma (SCC) at the base of the tongue. Chemo/immunotherapy was administered as a first-line treatment. Given the optimal response and the feasibility of surgery, after three cycles, the patient underwent a total glossectomy, bilateral neck dissection, and reconstruction with a thoraco-dorsal free flap. A histological examination found SCC with a residual cancer burden of 70% and free margins.
The mechanisms responsible for carcinogenesis after RT are still not completely clear. Diagnosis may be challenging due to the previous treatment; growth patterns are unusual, and lymphotropism is lower. Prognosis is usually poor since surgical resectability is often not achievable.
Radiation-induced malignancies are difficult to treat. Patient management should always be discussed at a multidisciplinary level. Future research is needed to assess whether the promising results of clinical studies with pre-operative immunotherapy in locally advanced HN SCC patients may be translated into radiation-induced cancers.
After 13 years, a 33-year-old woman treated with chemo-radiotherapy for nasopharyngeal carcinoma developed a locally advanced, radiation-induced, p16-negative oropharyngeal squamous cell carcinoma (SCC) at the base of the tongue. Chemo/immunotherapy was administered as a first-line treatment. Given the optimal response and the feasibility of surgery, after three cycles, the patient underwent a total glossectomy, bilateral neck dissection, and reconstruction with a thoraco-dorsal free flap. A histological examination found SCC with a residual cancer burden of 70% and free margins.
The mechanisms responsible for carcinogenesis after RT are still not completely clear. Diagnosis may be challenging due to the previous treatment; growth patterns are unusual, and lymphotropism is lower. Prognosis is usually poor since surgical resectability is often not achievable.
Radiation-induced malignancies are difficult to treat. Patient management should always be discussed at a multidisciplinary level. Future research is needed to assess whether the promising results of clinical studies with pre-operative immunotherapy in locally advanced HN SCC patients may be translated into radiation-induced cancers.
摘要：
背景：放射治疗（RT）是头颈部（HN）癌症的主要治疗方法，80%的患者接受这种治疗。辐射引起的恶性肿瘤代表了RT的威胁生命的长期影响，发病率为0.5%至15%。
方法：13年后，一名33岁接受鼻咽癌放化疗治疗的女性出现了局部晚期，辐射诱导，p16阴性口咽鳞状细胞癌（SCC）在舌根。化疗/免疫疗法作为一线治疗施用。鉴于最佳反应和手术的可行性，经过三个周期，患者接受了全舌骨切除术,双侧颈淋巴结清扫术,用胸背游离皮瓣重建。组织学检查发现SCC具有70％的残留癌症负担和自由边缘。
结论：RT后致癌机制仍不完全清楚。由于先前的治疗，诊断可能具有挑战性；生长模式不寻常，和淋巴功能较低。预后通常较差，因为通常无法实现手术可切除性。
结论：辐射诱发的恶性肿瘤难以治疗。患者管理应始终在多学科层面进行讨论。未来的研究需要评估局部晚期HNSCC患者术前免疫治疗临床研究的有希望的结果是否可以转化为辐射诱导的癌症。
方法：13年后，一名33岁接受鼻咽癌放化疗治疗的女性出现了局部晚期，辐射诱导，p16阴性口咽鳞状细胞癌（SCC）在舌根。化疗/免疫疗法作为一线治疗施用。鉴于最佳反应和手术的可行性，经过三个周期，患者接受了全舌骨切除术,双侧颈淋巴结清扫术,用胸背游离皮瓣重建。组织学检查发现SCC具有70％的残留癌症负担和自由边缘。
结论：RT后致癌机制仍不完全清楚。由于先前的治疗，诊断可能具有挑战性；生长模式不寻常，和淋巴功能较低。预后通常较差，因为通常无法实现手术可切除性。
结论：辐射诱发的恶性肿瘤难以治疗。患者管理应始终在多学科层面进行讨论。未来的研究需要评估局部晚期HNSCC患者术前免疫治疗临床研究的有希望的结果是否可以转化为辐射诱导的癌症。
