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头颈肿瘤精准放疗：基因组学, 影像组学&免疫学

2018年01月19日

编译：肿瘤资讯

来源：肿瘤资讯

Melvin Lee Kiang Chua

教授

新加坡国立癌症中心放疗科顾问医师、临床科学家

报告主题：头颈肿瘤精准放疗：基因组学、影像组学及免疫学

Melvin教授立足时下最前沿的精准医学，结合基因组学、影像组学及免疫学，阐述了头颈肿瘤（HNC）精准放疗策略。他强调了HNC疾病谱的变化，人乳头瘤病毒阳性口咽鳞癌（HPV+ OPSCC）发病率急剧升高，他认为病毒相关HNC和非病毒相关HNC是不同的，同时发现TCGA数据库HPV+ HNC和新加坡EBV+ 鼻咽癌（NPC）存在共性的基因改变。针对HPV+ OPSCC的新分期系统已被提出，但从根本上改变此类疾病的治疗决策还需要时间。HNC放疗的最佳剂量分割模式仍未确定，超分割放疗5年总生存率获益是8%，似乎等同于Meta分析报道的联合化疗的获益，因此在不适合化疗的局部区域晚期患者中改变剂量分割模式可以作为一种提高疗效的选择。自适应放疗作为一种新的精准放疗理念有望提高肿瘤治疗比。分子和功能影像能够反应肿瘤内部分子构成，为先发制人的自适应放疗提供了可能。此外，一种被称为影像组学（Radiomics）的高通量影像特征提取、选择和分析方法为肿瘤的风险分层及基于肿瘤实时变化的自适应放疗提供了基础。目前，免疫治疗快速发展，数据表明基因组学及影像组学能够揭示免疫治疗获益的分子事件，从而实现更好的风险分层。

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.