Head and neck cancer is notoriously challenging to treat in part because it constitutes an anatomically and biologically diverse group of cancers with heterogeneous prognoses. While treatment can be associated with significant late toxicities, recurrence is often difficult to salvage with poor survival rates and functional morbidity.^1,2 Thus, achieving tumor control and cure at the initial diagnosis is the highest priority. Given the differing outcome expectations (even within a specific sub-site like oropharyngeal carcinoma), there has been growing interest in personalizing treatment: de-escalation in selected cancers to decrease the risk of late toxicity without compromising oncologic outcomes, and intensification for more aggressive cancers to improve oncologic outcomes without causing undue toxicity. This risk stratification is increasingly accomplished using biomarkers, which can represent molecular, clinicopathologic, and/or radiologic data. In this review, we will focus on biomarker-driven radiotherapy dose personalization with emphasis on oropharyngeal and nasopharyngeal carcinoma. This radiation personalization is largely performed on the population level by identifying patients with good prognosis via traditional clinicopathologic factors, although there are emerging studies supporting inter-tumor and intra-tumor level personalization via imaging and molecular biomarkers.

众所周知，头颈癌的治疗极具挑战性，部分原因是它构成了一组解剖学和生物学上多样化的癌症，且预后各异。虽然治疗可能与显着的晚期毒性相关，但复发往往难以挽救，存活率和功能发病率都很低。^{1 , 2}因此，在初次诊断时实现肿瘤控制和治愈是重中之重。考虑到不同的结果期望（即使在口咽癌等特定亚部位），人们对个性化治疗越来越感兴趣：对选定的癌症进行降级治疗以降低晚期毒性风险而不影响肿瘤学结果，并强化治疗以获得更积极的治疗癌症以改善肿瘤学结果而不引起过度的毒性。这种风险分层越来越多地使用生物标志物来完成，生物标志物可以代表分子、临床病理学和/或放射学数据。在本次综述中，我们将重点关注生物标志物驱动的放射治疗剂量个性化，重点关注口咽癌和鼻咽癌。这种放射个性化主要是在人群水平上进行的，通过传统的临床病理因素识别预后良好的患者，尽管有新兴研究支持通过成像和分子生物标志物进行肿瘤间和肿瘤内水平的个性化。