編譯：腫瘤資訊
來源：腫瘤資訊
Melvin Lee Kiang Chua教授
新加坡國立癌症中心放療科 顧問醫師、臨床科學家
報告主題：頭頸腫瘤精准放療：基因組學、影像組學及免疫學
Melvin教授立足時下最前沿的精准醫學，結合基因組學、影像組學及免疫學，闡述了頭頸腫瘤（HNC）精准放療策略。他強調了HNC疾病譜的變化，人乳頭瘤病毒陽性口咽鱗癌（HPV+ OPSCC）發病率急劇升高，他認爲病毒相關HNC和非病毒相關HNC是不同的，同時發現TCGA數據庫HPV+ HNC和新加坡EBV+ 鼻咽癌（NPC）存在共性的基因改變。針對HPV+ OPSCC的新分期系統已被提出，但從根本上改變此類疾病的治療決策還需要時間。HNC放療的最佳劑量分割模式仍未確定，超分割放療5年總生存率獲益是8%，似乎等同于Meta分析報道的聯合化療的獲益，因此在不適合化療的局部區域晚期患者中改變劑量分割模式可以作爲一種提高療效的選擇。自適應放療作爲一種新的精准放療理念有望提高腫瘤治療比。分子和功能影像能夠反應腫瘤內部分子構成，爲先發制人的自適應放療提供了可能。此外，一種被稱爲影像組學（Radiomics）的高通量影像特征提取、選擇和分析方法爲腫瘤的風險分層及基于腫瘤實時變化的自適應放療提供了基礎。目前，免疫治療快速發展，數據表明基因組學及影像組學能夠揭示免疫治療獲益的分子事件，從而實現更好的風險分層。
英文原文
Precision Radiotherapy Approaches in Head and Neck Cancers-A Tripartite Marriage of Genomics, Radiomics, and Immunologics
Melvin Lee Kiang Chua
Clinician-Scientist, Consultant, Division of Radiation Oncology, National Cancer Centre Singapore
Topic: Precision Radiotherapy in Head and Neck Cancers: Genomics, Radiomics & Immunologics
Professor Melvin demonstrated the precision radiotherapy (RT) approaches for head and neck cancers (HNC) based on genomics, radiomics and immunologics. He emphasized the landscape change of HNC, especially the epidemic of human papilloma virus-positive oropharynx squamous cell carcinoma (HPV+ OPSCC). Virus-associated HNC is considered to be different from non-virus-associated HNC, and they found commonalities of genetic changes between TCGA HP+ HNC and Singapore Epstein-Barr virus-positive nasopharyngeal carcinoma (EBV+ NPC). Revised stage classification for HPV+ OPSCC had been proposed, but it has not yet been translated to a change in treatment paradigm for this disease. As for optimal RT dose fractionation, reported 5-year overall survival benefit of 8% with hyperfraction seemed equivalent to that from chemo-RT combination in Meta analysis. Hyperfraction RT might be a way to improve disease control for advanced disease unsuitable to receive chemo-radiotherapy. Recently, a novel precision RT concept, known as adaptive RT, has been proposed for improving the therapeutic ratio. The feasibility of adaptive RT is related to the onset of molecular and functional imaging, which offers information on molecular architecture of the tumour. Radiomics is a novel high throughput feature extraction and selection workflow to derive signatures for clinical prognostication and adapting RT based on real-time tumour changes. Additionally, the acute enthusiasm to incorporate immunotherapy in the management of cancers has also prompted the utility of immunotherapy-RT in HNC. Recent data suggests that genomics and radiomics have the potential to inform on the molecular processes underpinning responses to immunotherapy, and thereby facilitate better patient stratification.