Resumen
El cáncer de cabeza y cuello (CCC) es una entidad que engloba un conjunto de tumores con origen, diagnóstico, tratamiento y pronóstico similar. Su compleja presentación y manejo requieren de un enfoque multidisciplinar, con una especial atención a su tratamiento y a las secuelas asociadas a los mismos. La estadificación de estos tumores se basa en la clasificación de la AJCC, 8° edición. La toma de una biopsia del tumor primario o de sus metástasis es fundamental en todos los campos. La tomografía por emisión de positrones (PET) es la prueba de referencia para el diagnóstico en estadios no metastásicos. La radioterapia (RT) y la cirugía tienen resultados similares en tumores localizados. Los tumores localmente avanzados deben dividirse en resecables (preferencia a la cirugía) o irresecables (estándar con quimioterapia —QT— y RT concomitante). Los tumores metastásicos constan de una primera línea de tratamiento con inmunoterapia con o sin QT, habiendo en segunda línea múltiples fármacos con actividad antitumoral. La reevaluación periódica con panendoscopia, tomografía computadorizada (TC) y exploración física es el estándar en el seguimiento de estos pacientes.
Palabras clave
Cáncer de cabeza y cuello
Cisplatino
Inmunoterapia
Radioterapia
Abstract
Head and neck cancer (HNC) is an entity that encompasses a set of tumors with a similar origin, diagnosis, treatment, and prognosis. Their complex presentation and management require a multidisciplinary focus with special attention to treatment and the associated sequelae. The staging of these tumors is based on the Eighth Edition AJCC classification. Taking a biopsy of the primary tumor or its metastases is fundamental in all fields. A positron emission tomography (PET) scan is the reference test for diagnosis in non-metastatic stages. Radiotherapy (RT) and surgery have similar results in localized tumors. Locally advanced tumors must be divided into resectable (preference for surgery) or unresectable (standard therapy with chemotherapy (QT) and concomitant RT). The first line of treatment for metastatic tumors is immunotherapy with or without QT and the second line of treatment is multiple drugs with antitumor activity. Periodic re-evaluation with a panendoscopy, computed tomography (CT) scan, and a physical examination is the standard of care in the follow-up on these patients.
Keywords
Head and neck cancer
Cisplatin
Immunotherapy
Radiotherapy
Identifíquese
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Bibliografía
[1]
L.C. Iglesias , V. Arrazubi, N. Baste, A. Carral, B. Cirauqui, Y. Escobar, et al.
SEOM clinical guidelines for the treatment of head and neck cáncer (2017).
Clin Transl Oncol., (2018), 20 pp. 75-83
[2]
V. Paleri , T.G. Urbano, H. Mehanna, C. Repanos, J. Lancaster, T. Roques, et al.
Management of neck metastases in head and neck cáncer: United Kingdom National Multidisciplinary Guidelines.
J Laryngol Otol., (2016), 130 pp. S161-S169
[4]
G. Gatta , L. Botta, M.J. Sánchez, L.A. Anderson, D. Pierannunzio, L. Licitra.
Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: The EUROCARE-5 population-based study.
Eur J Cancer., (2015), 51 pp. 2130-2143
[5]
Incidence trends for human papillomavirus-related and unrelated oral squamous cell carcinomas in the United States.
J Clin Oncol., (2008), 26 pp. 612-619
[6]
M. Hashibe , P. Brennan, S.C. Chuang, S. Boccia, X. Castellsague, C. Chen, et al.
Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooledanalysis in the International Head and Neck Cancer Epidemiology Consortium.
Cancer Epidemiol Biomarkers Prev., (2009), 18 pp. 541-550
[7]
HPV-associated head and neck cancer: a virus-related cancer epidemic.
Lancet Oncol., (2010), 11 pp. 781-789
[8]
C.P. Chang , S.C. Chang, S.C. Chuang, J. Berthiller, G. Ferro, K. Matsuo, et al.
Age at start of using tobacco on the risk of head and neck cancer: Pooled analysis in the International Head and Neck Cancer Epidemiology Consortium (INHANCE).
Cancer Epidemiol., (2019), 63 pp. 101615
[9]
Molecular mechanisms of HPV induced carcinogenesis in head and neck.
Oral Oncol., (2014), 50 pp. 356-363
[10]
P.M. Hau , H.L. Lung, M. Wu, C.M. Tsang, K.L. Wong, N.K. Mak, et al.
Targeting Epstein-Barr Virus in Nasopharyngeal Carcinoma.
Front Oncol., (2020), 10 pp. 600
[11]
H. Konings , S. Stappers, M. Geens, B.Y. De Winter, K. Lamote, J.P. van Meerbeeck, et al.
A literature review of the potential diagnostic biomarkers of head and neck neoplasms.
Front Oncol., (2020), 10 pp. 1020
[12]
Molecular changes in the multistage pathogenesis of head and neck cancer.
Cancer Biomark., (2010), 9 pp. 325-339
[14]
F. Martín-Hernán , J.G. Sánchez-Hernández, J. Cano, J. Campo, J. del Romero.
Oral cancer.
HPV infection and evidence of sexual transmission. Med Oral Patol Oral Cir Bucal., (2013), 18 pp. e439-e444
[15]
K.K. Ang , J. Harris, R. Wheeler, R. Weber, D.I. Rosenthal, P.F. Nguyen-Tân, et al.
Human papillomavirus and survival of patients with oropharyngeal cancer.
N Engl J Med., (2010), 363 pp. 24-35
[16]
Molecular pathology of head and neck cancer: implications for diagnosis, prognosis, and treatment.
Annu Rev Pathol., (2009), 4 pp. 49-70
[20]
Examination of the patient with head and neck cancer.
Surg Oncol Clin N Am., (2015), 24 pp. 409-421
[21]
F.R. Miller , D. Hussey, M. Beeram, T. Eng, S. McGuff, R.A. Otto.
Positron emission tomography in the management of unknown primary head and neckcarcinoma.
Arch Otolaryngol Head Neck Surg., (2005), 131 pp. 626-629
[22]
An imaging- based classification for the cervical nodes designed as an adjunct to recent clinicallybased nodal classifications.
Arch Otolaryngol Head Neck Surg., (1999), 125 pp. 388-396
[23]
Role of 18F-FDG PET/CT in pre and post treatment evaluation in head and neck carcinoma.
World J Radiol., (2014), 6 pp. 177-191
[24]
E. Leoncini , V. Vukovic, G. Cadoni, R. Pastorino, D. Arzani, C. Bosetti, et al.
Clinical features and prognostic factors in patients with head and neck cancer: Results from a multicentric study.
Cancer Epidemiol., (2015), 39 pp. 367-374
[25]
TNM classification of malignant tumours, 8th ed, John Wiley & Sons, Inc,
[26]
B. Sullivan , S.H. Huang, J. Su, A.S. Garden, E.M. Sturgis, K. Dahlstrom, et al.
Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal Cancer Network for Staging (ICON-S): a multicentre cohort study.
Lancet Oncol., (2016), 17 pp. 440-451
[27]
P.F. Nguyen-Tân , Q. Zhang, K.K. Ang, R.S. Weber, D.I. Rosenthal, D. Soulieres, et al.
Randomized phase III trial to test accelerated versus standard fractionation in combination with concurrent cisplatin for head and neck carcinomas in the Radiation Therapy Oncology Group 0129 Trial: Long-term report of efficacy and toxicity.
J Clin Oncol., (2014), 32 pp. 3858-3867
[28]
E. Maghami , N. Ismaila, A. Alvarez, R. Chernock, U. Duvvuri, J. Geiger, et al.
Diagnosis and management of squamous cell carcinoma of unknown primary in the head and neck cancer: ASCO Guideline.
J Clin Oncol., (2020), 38 pp. 2570-2596
[29]
Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients.
Radiother Oncol., (2009), 92 pp. 4-14
[31]
R. Hitt , J.J. Grau, A. López-Pousa, A. Berrocal, C. García-Girón, A. Irigoyen, et al.
A randomized phase III trial comparing induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as treatment of unresectable head and neck cancer.
Ann Oncol., (2014), 25 pp. 216-225
[32]
R. Hitt , L. Iglesias, A. López-Pousa, A. Berrocal-Jaime, J.J. Grau, C. García-Girón, et al.
Long-term outcomes of induction chemotherapy followed by chemoradiotherapy vs chemoradiotherapy alone as treatment of unresectable head and neck cancer: follow-up of the Spanish Head and Neck Cancer Group (TTCC) 2503 Trial.
Clin Transl Oncol. En prensa, (2020),
[33]
Induction TPF followed by concomitant treatment versus concomitant treatment alone in locally advanced head and neck cancer. A phase II-III trial.
Ann Oncol., (2017), 28 pp. 2206-2212
[34]
E.E.W. Cohen , T.G. Karrison, M. Kocherginsky, J. Mueller, R. Egan, C.H. Huang, et al.
Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer.
J Clin Oncol., (2014), 32 pp. 2735-2743
[35]
The Role of Adjuvant Chemotherapy in Surgically Managed, p16-Positive Oropharyngeal Squamous Cell Carcinoma.
JAMA Otolaryngol Head Neck Surg., (2017), 143 pp. 253-259
[36]
Cisplatin-based chemotherapy options for recurrent and/or metastatic squamous cell cancer of the head and neck.
Clin Med Insights Ther., (2013), 2013
[37]
Platinum-based chemotherapy plus cetuximab in head and neck cancer.
N Engl J Med., (2008 Sep 11), 359 pp. 1116-1127
[38]
Immunotherapy for head and neck cancer: Recent advances and future directions.
Oral Oncol., (2019), 99 pp. 104460
[39]
W.M. Mendenhall , R.W. Hinerman, R.J. Amdur, R.S. Malyapa, C.D. Lansford, J.W. Werning, et al.
Postoperative radiotherapy for squamous cell carcinoma of the head and neck.
Clin Med Res., (2006), 4 pp. 200-208
[40]
J. Bernier , J.S. Cooper, T.F. Pajak, M. van Glabbeke, J. Bourhis, A. Forastiere, et al.
Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501).
Head Neck., (2005), 27 pp. 843-850
[41]
M. Merlano , M. Benasso, R. Corvó, R. Rosso, V. Vitale, F. Blengio, et al.
Five-year update of a randomized trial of alternatin gradiotherapy and chemotherapy compared with radiotherapy alone in treatmentof unresectable squamous cell carcinoma of the head and neck.
J Nat Cancer Inst., (1996), 88 pp. 583-589
[42]
J.A. Bonner , P.M. Harari, J. Giralt, N. Azarnia, D.M. Shin, R.B. Cohen, et al.
Radiotherapy plus Cetuximab for Squamous-CellCarcinoma of the Head and Neck.
New Engl J Med., (2006), 354 pp. 567-578
[43]
Organ preservation for advanced larynx cancer: issues and outcomes.
J Clin Oncol., (2015), 33 pp. 3262-3268
[44]
M.R. Posner , D.M. Hershock, C.R. Blajman, E. Michiewicz, E. Winquist, V. Gorbounova, et al.
Cisplatin and Fluorouracil alone or with Docetaxel in Head and Neck Cancer.
N Engl J Med., (2007), 357 pp. 1705-1715
[46]
J.B. Vermorken , R. Mesia, F. Rivera, E. Remenar, A. Kawecki, S. Rottey, et al.
Platinum-based chemotherapy plus cetuximab in head and neck cancer.
N Engl J Med., (2008), 359 pp. 1116-1127
[47]
R. Hitt , A. Irigoyen, H. Cortes-Funes, J.J. Grau, J.A. García-Sáenz, J.J. Cruz-Hernandez, Spanish Head and Neck Cancer Cooperative Group (TTCC).
Phase II study of the combination of cetuximab and weekly paclitaxel in the first-line treatment of patients with recurrent and/or metastatic squamous cell carcinoma of head and neck.
Ann Oncol., (2012), 23 pp. 1016-1022
[48]
B. Burtness , K.J. Harrington, R. Greil, D. Souliéres, M. Tahara, G. de Castro, et al.
Pembrolizumab alone or with chemotherapy versus cetuximab with chemotherapy for recurrent or metastatic squamous cell carcinoma of the head and neck (KEYNOTE-048): a randomised, open-label, phase 3 study.
Lancet., (2019), 394 pp. 1915-1928
[49]
R.L. Ferris , G. Blumenschein, J. Fayette, J. Guigay, A.D. Colevas, L. Licitra, et al.
Nivolumab for recurrent squamous-cell carcinoma of the head and neck.
N Engl J Med., (2016), 375 pp. 1856-1867
[50]
Docetaxel in the treatment of squamous cell carcinoma of the head and neck.
Ther Clin Risk Manag., (2008), 4 pp. 865-886
[51]
Methotrexate, an attractive agent for palliation in head and neck cancers.
South Asian J Cancer., (2014), 3 pp. 229
[52]
J.T. Chang , L.C. See, C.T. Liao, L.H. Chen, W.M. Leung, S.W. Chen, et al.
Early Stage Nasopharyngeal Carcinoma: Radiotherapy Dose and Time Factors in Tumor Control.
Jpn J Clin Oncol., (1998), 28 pp. 207-213
[53]
B. Zhang , M.M. Li, W.H. Chen, J.F. Zhao, W.Q. Chen, Y.H. Dong, et al.
Association of chemoradiotherapy regimens and survival among patients with nasopharyngeal carcinoma.
JAMA Netw Open., (2019), 2 pp. e1913619
[54]
Gemcitabine and Cisplatin induction chemotherapy in nasopharyngeal carcinoma.
N Engl J Med., (2019), 381 pp. 1124-1135
[55]
N. Toumi , W.B. Kridis, W. Mnejja, R. Bouzguenda, A. Khanfir, A. Ghorbel, et al.
TPF induction chemotherapy followed by concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: Long term results of a Tunisian series.
Cancer Radiother., (2018), 22 pp. 216-221
[56]
Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma: a multicentre, randomised, open-label, phase 3 trial.
Lancet, (2016), 388 pp. 1883-1892
