头颈部肿瘤38例放射治疗的护理

放射治疗是利用辐射能对生物组织作用后的临床效应来作为治疗恶性肿瘤的主要手段之一,头颈部肿瘤治疗首选放疗。在放疗过程中,常出现不同程度的放疗反应,不仅给患者带来痛苦,而且严重反应可使患者中断治疗。为使放疗顺利进行,应当做好各方面的临床护理工作,现将头颈部肿瘤放疗的护理介绍如下。     

头颈部肿瘤放射治疗对甲状腺功能的影响

报道５５例头颈部肿瘤放射治疗（放疗）后甲状腺功能发生的变化。其中１６例放疗后促甲状腺激素（ＴＳＨ）水平高于正常，８例Ｔ４水平下降，但临床上出现甲状腺功能减退（甲减）者仅２例，多数病人处于亚临床表现。提示临床不能忽视放疗对甲状腺功能的影响。     

局部晚期头颈部鳞癌同期放疗联合不同含铂方案化疗的回顾性分析

目的 观察奈达铂（Nedaplatin,NDP）、奥沙利铂（Oxaliplatin,L-OHP）及顺铂（Cisplatin, DDP）联合放化疗分别对局部晚期头颈部鳞癌的治疗效果.方法 选取我院2012年5月至2017年5月收治的97例局部晚期头颈部鳞癌者进行回顾性分析,患者中33例经NDP＋5-Fu（5-氟尿嘧啶,5-Fu） （NDP组）治疗,32例经L-OHP＋5-Fu（L-OHP组）治疗,32例经DDP＋5-Fu（DDP组）治疗,3组均联合放疗的治疗方案.比较3组的治疗效果和不良反应.结果 NDP组的有效率为78.8%,略高于L-OHP组的75.0%,而DDP组的有效率为62.5%,3组比较差异有统计学意义（χ2=2.365,P=0.031）.3组患者在治疗过程中均出现各种不同程度的不良反应,无Ⅳ度不良反应出现.NDP 的各项不良反应的发生率为（49.78 ±3.22）%低于L-OHP组（50.89±3.47）%,L-OHP组低于DDP 组（53.26±4.19）%.但3组比较差异无统计意义（P=0.099）.结论 NDP与L-OHP对头颈部鳞癌患都具有较好的疗效,NDP略优于L-OHP.     

Ⅲ期食管鳞癌的术前放射治疗

食管癌的治疗以手术治疗为主，放射治疗次之。目前，多主张综合治疗。国内、外综合治疗的资料以术前放射治疗较多，但对术前放疗的价值评价不一。本文通过分析我院且期食管癌术前放射治疗的结果，确定术前放射治疗对对期食管癌的作用。1材料与方法1．1临床资料我院1984年6月～1987年6月，共施行食管鳞癌手术522例，单纯手术434例（以下简称手术组），其中三期病例153例；术前计划性放疗后行手术64例（以下简称术前放疗组），其中正期病例17例；其它综合治疗24例。全部病例均随访5年以上，失访按死亡计。两组病例的构成比例相近，无统计学差…     

重组人血管内皮抑制素联合放化疗对晚期头颈部鳞癌患者生存质量的影响

目的探讨重组人血管内皮抑制素联合放化疗对晚期头颈部鳞癌患者生存质量的影响。方法选取我院2016年1月至2018年1月收治的86例晚期头颈部鳞癌患者作为研究对象,按照治疗方式不同将其分为观察组(43例,重组人血管内皮抑制素联合放化疗)和对照组(43例,常规放化疗)。比较两组的疾病控制情况、急性不良反应发生情况、生存质量、希望水平及心理弹性。结果观察组的疾病控制率及缓解率均明显高于对照组(P<0.05)。两组各项急性不良反应发生情况基本相似(P>0.05)。治疗后,观察组的生存质量、HHI、CD-RISC评分均明显高于对照组(P<0.05)。结论重组人血管内皮抑制素联合放化疗能提高晚期头颈部鳞癌患者的疾病控制率及缓解率,改善患者的生存质量。     

适形调强放射治疗联合黄芪多糖注射液对头颈部肿瘤的效果

目的:观察适形调强放射疗法(IMRT)联合黄芪多糖注射液对头颈部肿瘤的治疗效果及免疫力变化情况。方法:选取2016年8月～2017年8月我院收治的80例头颈部肿瘤患者为研究对象,随机分为甲组和乙组各40例。甲组给予IMRT治疗,乙组在甲组基础上给予黄芪多糖注射液联合治疗,比较两组患者治疗效果与免疫力情况。结果:两组患者近期治疗总有效率比较无明显差异(P0.05);治疗前,两组患者免疫指标水平比较无显著差异(P0.05);治疗后,乙组各项免疫指标水平与SF-36评分均高于甲组(P0.05);乙组不良反应发生率显著低于甲组(P0.05)。结论:应用适形调强放射疗法联合黄芪多糖注射液治疗头颈部肿瘤,可有效提升患者治疗效果,增强机体免疫力,安全性较高,值得临床推广。     

头颈部鳞癌的研究趋势及新进展

头颈部鳞癌（Head and Neck Squamous Cell Carcinoma, HNSCC）为发生于口腔、咽、喉黏膜上皮的鳞癌,吸烟、酗酒与促进口腔及喉部鳞癌形成存在相关性,咽部鳞癌与人类乳头状瘤病毒感染有关。头颈部鳞癌有多种治疗方式,特别是以分子靶向治疗为代表的药物治疗快速发展。本文具体探讨与分析了头颈部鳞癌的流行病学状况,阐述了头颈部鳞癌的形成机制,综述了头颈部鳞癌的分子靶向治疗进展：西妥昔单抗、免疫检查点分子抑制剂、贝伐珠单抗。     

头颈部转移性鳞癌颈部淋巴结中EBV与HPV的检测及临床意义

头颈部恶性肿瘤,尤其是上呼吸道和上消化道来源者,90%以上是鳞状细胞癌。在头颈部各器官中,许多原发病灶十分隐匿或位于黏膜下,临床上往往在患者出现颈部淋巴结转移后才被发现。这些患者临床称之为原发灶不明的头颈部转移性鳞癌,其发病率约占所有头颈部鳞癌的3%～9%[1]。颈部有着丰富的淋巴组织,其不仅可接受颈部诸多器官的淋巴引流,还可以接受胸、腹、盆腔及四肢的淋巴引流,所以原发灶不明的颈部转移性鳞癌的诊断和处理至今仍是临床上的棘手问题[2]。为探索这类疾病原发病灶的可能来源,本研究运用原位杂交方法检测头颈部转移性鳞癌颈部淋巴…     

毫米波联合止痛药治疗癌性疼痛

非阿片类药物治疗癌痛副作用较小，但止痛效果较盟，对癌痛剧烈的患效果甚微，阿片类药物止痛效果较强，副作用较大，反复使用产生身体依赖性和成瘾性，大剂量引起呼吸抑制导致昏迷。因此癌症患在临床治疗上常常出现“痛与控”的矛盾问题。为探讨解决这一矛盾的其他有效方法，采用毫米波辅助治疗癌痛。     

老年晚期食管鳞癌放射治疗止痛效果分析

老年晚期食管癌预后差,本组经对54 例老年晚期食管癌病人进行放射治疗及对症支持治疗, 生存质量明显提高,现报告如下。1 资料与方法1.1 资料均为住院病人,男42例,女12例,年龄60～76岁。症状主要为进食困难和胸背部疼 痛,病理诊断均为鳞癌,位于胸上段6例,胸中段34例,胸下段14例。病灶长度5.1～12.5cm ,平均8.5cm。X线分型为髓质型39例,蕈伞型8例,溃疡型5例,缩窄型2例,无明显梗阻或轻 度梗阻占29.6％。有锁骨上淋巴结转移5例。1.2 治疗方法本组老年晚期食管癌病人均采用在模拟机下定位,照射野在病灶上下各放3～4 cm,野宽平均…     

头颈部鳞癌患者血清新蝶呤水平测定

目的研究头颈部鳞癌患者细胞免疫状态。方法采用双抗体夹心ＥＬＩＳＡ法，测定３９例头颈部鳞癌患者血清新蝶盼水平。结果头颈鳞癌组血清新蝶呤水平（１４． ８８±８． ５９ｎｇ／ｍｌ）较正常对照组（５． ２７±３．６６ｎｇ／ｍｌ）明显增高（ Ｐ ＜０．０１）。结论提示头颈部鳞癌患者体内细胞免疫系统处于异常激活状态。     

局部晚期头颈部鳞状细胞癌术后同期放化疗的疗效分析

目的观察局部进展期头颈部鳞状细胞癌术后放疗,同期多西他赛联合顺铂方案化疗的疗效,探讨提高术后放疗疗效的方法。方法回顾性分析2008年3月至2011年12月行术后同期放化疗的79例头颈部鳞状细胞癌患者治疗资料,原发灶位于口咽、喉或喉咽,术后有以下高危因素:淋巴结包膜外侵犯;手术切缘阳性;病理学为T4或N2、N3。根据复发风险处方照射剂量,同期多西他赛联合顺铂方案化疗,3周1次。用Kaplan-Meier法分析生存获益及无进展生存率,RTOG毒性标准评价放疗引起的急性与晚期毒性反应,NCI化疗毒性标准评价化疗毒性反应。结果中位随访38个月,全组共9例发生局部区域复发。2年局部区域控制率92%,2年无进展生存率75%,2年总体生存率87%。Ⅲ度或以上治疗相关毒性反应:粒细胞缺乏(59%),黏膜损伤(47%),口干(6%),肌纤维化(10%),吞咽困难(8%)及皮肤损伤(13%),9例患者发生咽瘘,无治疗相关死亡。结论局部进展期头颈部鳞状细胞癌术后放疗,同期多西他赛联合顺铂方案化疗是安全、有效的治疗手段。     

Evolving role of human papillomavirus as a clinically significant biomarker in head and neck squamous cell carcinoma

Introduction: The majority of squamous cell carcinoma (SCC) of the oropharynx, one of the sites within the head and neck region, is now associated with high-risk human papillomavirus (HPV) in North America. Several modalities are available to determine the HPV status, however, the understanding of each assay in its application and limitations is essential for accurate interpretation and appropriate utilization of results in management of these patients.

Areas covered: This expert review will cover the role of HPV in head and neck squamous cell carcinoma (HNSCC), indications for HPV testing, HPV detection methods in tumors, saliva and serum, and exploiting HPV status as a prognostic biomarker of clinical outcome in HNSCC.

Expert commentary: The HPV status is the most significant diagnostic and prognostic biomarker in HNSCC, specifically in the oropharynx. Research underway is currently delineating the role of HPV and p16 testing in non-oropharyngeal sites. While the feasibility of non-invasive serum and saliva testing for HPV detection has been established, the clinical application of these assays is still evolving.     

局部或区域晚期头颈鳞癌放化疗联合治疗现状和展望

头颈部鳞状细胞癌的全身治疗包括细胞毒药物治疗（简称化疗）、靶向治疗和支持治疗;而局部治疗主要包括放射治疗和手术。放化疗联合是局部晚期或区域晚期头颈部鳞癌主要治疗模式,包括同步化放疗、诱导化疗、序贯化放疗。本文综述了原发于口腔、口咽、下咽、喉的鳞癌的化放疗联合治疗现状和进展。     

放疗联合奈达铂同步治疗老年人头颈鳞癌的疗效分析

目的评价放疗联合奈达铂化疗治疗老年人头颈鳞癌的疗效和毒副反应。方法对25例老年人头颈部鳞癌采用放疗同步每周联合小剂量奈达铂化疗,观察临床疗效及毒副反应情况。结果总有效率达为80%,1、2年生存率分别为72%、44%。治疗期间主要毒副反应为白细胞减少,口腔黏膜反应,恶心、呕吐及放射性脑损伤。结论放疗联合奈达铂同步治疗老年人头颈鳞癌具有较好疗效,毒副作用可耐受。     

立体聚焦支持护理在头颈部肿瘤放疗患者中的应用

目的 观察立体聚焦支持护理在头颈部肿瘤放疗患者中的应用效果.方法 将2016年1月至2016年6月收治于本院的头颈部放疗患者112例作为研究对象,随机分为对照组与试验组各56例,对照组接受常规放疗护理,试验组接受立体聚焦支持护理,比较干预后两组头颈部肿瘤放疗病例在各相关观察指标方面的差异.结果 试验组头颈部肿瘤放疗病例干预后的生活质量评分和护理满意度评分均显著高于对照组同类病例,差异有统计学意义(P<0.05).结论 采用立体聚焦支持护理对头颈部肿瘤放疗患者实施干预,在提升该类病例生活质量及护理满意度方面均具备积极效应.     

Endu combined with concurrent chemotherapy and radiotherapy for stage IIB-IVA cervical squamous cell carcinoma patients

BACKGROUNDIn recent years, the incidence of cervical cancer has increased with increasing life pressures and changes in women''s social roles, posing a serious threat to women''s physical and mental health.AIMTo explore the clinical effect of Endo combined with concurrent radiotherapy and chemotherapy in the treatment of advanced cervical squamous cell carcinoma.METHODSA total of 120 patients admitted to the oncology department of our hospital were selected as the research subjects. They were equally divided into the test group and the control group (60 patients each) with a random number table. The test group was treated with Endo combined with concurrent radiotherapy and chemotherapy, and the control group was treated with concurrent radiotherapy and chemotherapy. We compared the serum thymidine kinase 1 (TK1), human epididymis protein 4 (HE4), vascular endothelial growth factor (VEGF), and squamous cell carcinoma-associated antigen (SCC-Ag) levels, the clinical effects and survival before and after radiotherapy and chemotherapy, the quality score, and the 3-year follow-up outcomes between the two groups.RESULTSAfter chemotherapy, the complete remission + partial remission rate was 85.00% in the test group and 68.33% in the control group; the difference was not statistically significant (P > 0.05). Before chemotherapy, the serum TK1, HE4, VEGF, and SCC-Ag levels of the two groups were not significantly different (P > 0.05). After chemotherapy, the levels of serum TK1 (1.27 ± 0.40 pmol/L), HE4 (81.4 ± 24.0 pmol/L), VEGF (235.1 ± 38.0 pg/mL), and SCC-Ag (1.76 ± 0.55 ng/mL) were lower than those in the control group [TK1 (1.58 ± 0.51 pmol/L), HE4 (98.0 ± 28.6) pmol/L, VEGF (284.2 ± 54.1 pg/mL), and SCC-Ag (2.34 ± 0.78 ng/mL)]. The difference was statistically significant (P < 0.05). Before chemotherapy, there were no significant differences in the physical, role, mood, cognition, social and symptom scale scores of the two groups (P > 0.05). After chemotherapy, the physical, role, mood, cognitive and social scores were higher in the test group than in the control group, and the difference was statistically significant (P < 0.05). The symptom scale scores of the test group were all lower than those of the control group, and the difference was statistically significant (P < 0.05). The 3-year progression-free survival (PFS) rate was 43.33% in the test group and 26.67% in the control group; the overall survival (OS) rate was 48.33% in the test group and 33.33% in the control group; the differences were not statistically significant (P > 0.05). The 3-year PFS time of the test group was 20.0 mo, which was longer than that of the control group (15.0 mo), and the difference was significant (P < 0.05). The OS time of the test group was 30.0 mo, which was longer than that of the control group (18.0 mo), and the difference was significant (P < 0.05).CONCLUSIONEndo combined with concurrent radiotherapy and chemotherapy for the treatment of advanced cervical squamous cell carcinoma has a positive effect on reducing the level of tumor markers in patients, prolonging the PFS and OS times of patients, and improving the quality of life.     

Concurrent chemoradiotherapy using gemcitabine and nedaplatin in recurrent or locally advanced head and neck squamous cell carcinoma

BACKGROUNDPatients with recurrent or locally advanced head and neck squamous cell carcinoma (HNSCC) typically have limited treatment options and poor prognosis. AIMTo evaluate the efficacy and safety of two drugs with potent radio-sensitization properties including gemcitabine and nedaplatin as concurrent chemoradiotherapy regimens in treating HNSCC.METHODSThis single-arm prospective study enrolled patients with HNSCC to receive gemcitabine on days 1 and 8 and nedaplatin on days 1 to 3 for 21 days. Intensity-modulated radiation therapy with a conventional fraction was delivered 5 days per week. Objective response rate (ORR), disease control rate, and toxicity were observed as primary endpoints. Overall survival (OS) and progression free survival were recorded and analyzed as secondary endpoints. RESULTSA total of 24 patients with HNSCC were enrolled. During the median 22.4-mo follow-up, both ORR and disease control rate were 100%. The one-year OS was 75%, and one-year progression-free survival (PFS) was 66.7% (median PFS was 15.1 mo). Recurrent HNSCC patients had a poorer prognosis than the treatment-naïve patients, and patients who achieved complete response had better survival than those in the PR group (all P < 0.05). The most common grade 1-4 (100%) or grade 3-4 toxicities (75%) were hematological, and the most common grade 3-4 non-hematological toxicity was mucositis in 17 (71%) patients.CONCLUSIONGemcitabine plus nedaplatin with concurrent chemoradiotherapy is a therapeutic option for HNSCC with predictable tolerability. Considering the high adverse event rate, the optimized dose and schedule must be further explored.