頭頸部がんとHPV—男女区別のないHPVワクチン定期接種に向けて—Head and neck cancer and HPV: Toward gender-neutral vaccination
神戸大学大学院医学研究科耳鼻咽喉科頭頸部外科学分野Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine
耳鼻咽喉科が扱う領域は、呼吸や摂食・嚥下など生命の維持に欠かすことができない役割と、嗅覚や味覚、音声によるコミュニケーションなど生活の質に直結した様々な機能を担っている。頭頸部がんの治療では、他の領域以上に、根治と生活の質(QOL)の両立が求められ、この20年間に、放射線治療に白金製剤を同時併用する化学放射線療法、内視鏡や手術支援ロボットを用いた低侵襲手術、分子標的薬や免疫チェックポイント阻害薬、粒子線治療、がん光免疫療法(PIT)、ホウ素中性子補足療法(BNCT)など、全く新しい機序に基づく治療法が開発されてきた。しかし、国民に健康思考が浸透し、喫煙に起因する喉頭がんが減少する一方、ヒト乳頭腫ウイルス(HPV)が発症に関与する中咽頭がんが年々増加している。既に米国では、同じくHPVに関連する子宮頸がんの発生数を上回っており、男子へのHPVワクチン定期予防接種は喫緊の課題となっている。
The head and the neck play indispensable roles in sustaining life, such as breathing, eating, and swallowing as well as various functions related to quality of life, such as olfaction, taste, and verbal communication. In the treatment of head and neck cancer, radical cure and maintaining the quality of life are paramount. Over the past 20 years, substantial advancements, including cisplatin-based chemoradiotherapy, minimally invasive surgery using endoscopes and surgical robots, molecular targeted drugs, immune checkpoint inhibitors, particle therapy, photoimmunotherapy, and boron neutron capture therapy, have been developed. However, a shift in the epidemiology of head and neck cancers has been observed. Laryngeal cancers caused by smoking are decreasing as the public becomes more conscious about their health. However, human papillomavirus (HPV)-related oropharyngeal cancers are increasing annually. In the United States, the number of oropharyngeal cancer cases has already exceeded that of cervical cancer, suggesting the need for routine HPV vaccination for boys, promoting a gender-neutral vaccination approach.
Key words: human papillomavirus; head and neck cancer; gender-neutral vaccination; p16-positive oropharyngeal cancer; cervical cancer
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