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1.
The utilization of combined chemoradiation therapy has recently increased in the treatment of head and neck cancers. This patient population is significantly more prone to various oral complications during and after medical therapy. Oral complications and long-term effects include mucositis, xerostomia, alterations in taste, vascular compromise, mucosal thinning and increased risk of rampant caries and periodontal disease. The most serious oral complication that can arise is osteoradionecrosis. Managing patients properly prior to medical treatment can help decrease these potential complications during and after treatment. This purpose of this article is to review the different radiation and chemotherapy regimens used to treat patients with head and neck cancers, as well as protocols in the dental management of these patients before, during, and after medical treatment.  相似文献   

2.
Oxidative species, including reactive oxygen species (ROS), are components of normal cellular metabolism and are required for intracellular processes as varied as proliferation, signal transduction, and apoptosis. In the situation of chronic oxidative stress, however, ROS contribute to various pathophysiologies and are involved in multiple stages of carcinogenesis. In head and neck cancers specifically, many common risk factors contribute to carcinogenesis via ROS‐based mechanisms, including tobacco, areca quid, alcohol, and viruses. Given their widespread influence on the process of carcinogenesis, ROS and their related pathways are attractive targets for intervention. The effects of radiation therapy, a central component of treatment for nearly all head and neck cancers, can also be altered via interfering with oxidative pathways. These pathways are also relevant to the development of many benign oral diseases. In this review, we outline how ROS contribute to pathophysiology with a focus toward head and neck cancers and benign oral diseases, describing potential targets and pathways for intervention that exploit the role of oxidative species in these pathologic processes.  相似文献   

3.
This article focuses on squamous cell carcinoma of the head and neck (SCCHN), the most common malignancy of the head and neck area. Early detection limits morbidity of treatment and increases the chances of a cure. The treatment of SCCHN is often multidisciplinary in nature and provides a model for how multimodality therapy may be applied for optimal patient management. The role of surgery in SCCHN is continually undergoing evolution, and the surgeon's role in the multidisciplinary treatment of head and neck cancers has changed as more cancers are being treated by chemoradiotherapy. Salvage surgery has become more common, and with it the increased challenges in managing metastatic disease to neck nodes as well as managing failure of organ preservation treatments. Surgeons continue to develop and refine reconstruction techniques to optimize cosmetic and functional outcomes.  相似文献   

4.
BackgroundThe number of cancer survivors in the general population is increasing. Oral and dental status affects patients' quality of life and oral function, which, in turn, may affect nutritional intake and general health. The authors review the importance of oral health and the role of the oral health care provider in supporting dietary intake and providing nutritional guidance.MethodsThe authors provide a brief review of oral complications of therapy and nutritional guidelines for patients with head and neck cancer.ResultsOral adverse effects of head and neck cancer treatment include salivary gland dysfunction, taste change, orofacial pain and mucosal sensitivity, oral infection, tissue defects and necrosis, trismus and fibrosis, progressive dental and periodontal disease, and problems with prosthesis function.ConclusionsManaging oral adverse effects of treatment may have an impact on dietary and nutritional intake, as well as on quality of life. Dietary modifications may be needed because of the patient's oral function and may include modification of food texture and flavor, as well as the use of dietary supplements.Clinical ImplicationsAs part of the patient's health care team, dental care professionals should be aware of the oral adverse effects of cancer therapy, as well as their role in recognizing and treating the resulting oral conditions. In addition, they should provide guidance to patients to support their oral dietary and nutritional intake.  相似文献   

5.
Patients with head and neck cancer are often malnourished and have a high incidence of postoperative complications. Studies of patients with head and neck cancer receiving immunonutrition in the perioperative period have suggested, but not conclusively demonstrated, benefit. This study reviews randomised trials comparing perioperative standard polymeric nutrition or no nutritional supplementation with immunonutrition in the treatment of head and neck cancer. Electronic databases were searched; reference lists checked and letters sent requesting details of further data. Data were combined to estimate the common relative risk of postoperative complications (wound infections, fistula formation, death and length of hospital stay), and associated 95% confidence intervals. Random effects models were used.10 trials of polymeric nutritional supplementation with immunonutrition were identified; one compared two types of immunonutrition. There was little evidence of heterogeneity. Pooled estimates showed a reduction in length of hospital stay by 3.5 days (95% CI 0.7 to 6.3 day, P < 0.01). No reductions in clinical complications were seen. Perioperative immunonutrition is associated with reduced length of hospital stay; the mechanism is unclear as other outcomes were not improved. Trials were small with incomplete reporting of outcomes. An adequately powered trial is required to substantiate benefit.  相似文献   

6.
Patients who undergo treatment for head and neck cancers often suffer from acute or late reactions to therapy. Severity of these oral complications may be based on the location and extent of tumor, as well as the type and extent of treatment. Some complications are transient, whereas others require a lifetime of management secondary to damage that results in permanent dysfunction. Patients who have a history of head and neck cancers are also at an increased risk for recurrences or second malignancies, and therefore require close follow-up. Dental professionals should provide preventive and supportive care, including education and symptom management, for patients experiencing oral complications related to cancer therapy, and should closely monitor patients' level of distress, ability to cope, and treatment response.  相似文献   

7.
Most cancers contain a small sub-population of cells that are endowed with self-renewal, multipotency, and a unique potential for tumor initiation. These properties are considered hallmarks of cancer stem cells. Here, we provide an overview of the field of cancer stem cells with a focus on head and neck cancers. Cancer stem cells are located in the invasive fronts of head and neck squamous cell carcinomas (HNSCC) close to blood vessels (perivascular niche). Endothelial cell-initiated signaling events are critical for the survival and self-renewal of these stem cells. Markers such as aldehyde dehydrogenase (ALDH), CD133, and CD44 have been successfully used to identify highly tumorigenic cancer stem cells in HNSCC. This review briefly describes the orosphere assay, a method for in vitro culture of undifferentiated head and neck cancer stem cells under low attachment conditions. Notably, recent evidence suggests that cancer stem cells are exquisitely resistant to conventional therapy and are the "drivers" of local recurrence and metastatic spread. The emerging understanding of the role of cancer stem cells in the pathobiology of head and neck squamous cell carcinomas might have a profound impact on the treatment paradigms for this malignancy.  相似文献   

8.
Patients with head and neck cancers need a percutaneous endoscopic gastrosotomy (PEG) before start of treatment to ensure adequate nutrition because worsening dysphagia during chemo radiation [Nicholson FB, Korman MG, Richardson MA. Percutaneous endoscopic gastrostomy: a review of indications, complications and outcome. J. Gastroenterol Hepatol 2000; 15: 21–5; Beer KT, Krause KB, Zuercher T, Stanga Z. Early percutaneous endoscopic gastrostomy insertion maintains nutritional state in patients with aerodigestive tract cancer. Nutr Cancer 2005; 52: 29–34.]. However implantation of original tumor to the gastrostomy exit site is rare but serious complication of this procedure and here we report a case of PEG site metastasis along with relevant review of literature.  相似文献   

9.
An evaluation is presented of the nutritional status of 30 patients out of the 45 submitted to head and neck surgery, involving the buccal cavity, in the Maxillofacial Surgery Service of the General Hospital "Gregorio Mara?ón" of Madrid, between October 1985 and December 1986, before and after being submitted to excision of a tumour in the head or neck, by administration, in the postoperative period, of a liquid comprehensive diet via a nasogastric catheter. Neither in the postoperative period nor after stopping the enteral nutrition was the existence of malnutrition detected, in any of the parameters studied. One patient inhaled gastric juice with a fatal outcome, while the rest of the patients had no severe complications. Therefore, we think that the administration of enteral nutrition in this kind of patient is very useful and is indeed necessary to avoid energy-protein malnutrition during the postoperative period. At the same time it avoids possible infection by food remaining in the oral cavity.  相似文献   

10.
Lymph node status is the single most important prognostic factor in head and neck cancer because lymph node involvement decreases overall survival by 50%. Appropriate management of the regional lymphatics, therefore, plays a central role in the treatment of the head and neck cancer patients. Performing an appropriate neck dissection results in minimal morbidity to the patient, provides invaluable data to accurately stage the patient, and guides the need for further therapy. The purposes of this article are to present the history and evolution of neck dissections, including an update on the current state of nomenclature and current neck dissection classification, describe the technique of the most common neck dissection applicable to oral cavity cancers, and discuss some of the complications associated with neck dissection. Finally, a brief review of sentinel lymph node biopsy will be presented.  相似文献   

11.
症状群评估较单一症状评估能便于综合分析,更有利于抓住核心症状,解决主要矛盾。头颈部肿瘤由于解剖位置的特殊性,在疾病发展及治疗的不同阶段,患者出现多种特异性症状,影响生活质量。目前,国内针对头颈部肿瘤患者症状群评估的研究开展较少,且缺乏中文版头颈部肿瘤患者症状群特异性评估工具。本文就头颈肿瘤患者症状群评估工具研究现状做一综述。  相似文献   

12.
Oral cancer and the oral sequelae of treatment for oral and other malignancies can significantly affect a patient's oral and systemic health, as well as have a profound impact on quality of life. Compromised oral health prior to, during, and following cancer therapy can affect treatment outcomes. Increasingly, dental professionals in the community are being called upon to provide care for these individuals. Radiation therapy is routinely used for tumors of the head and neck, delivering a concentrated radiation dose to the tumor, but also to the immediately surrounding tissue. Oral complications are related to the site radiated and the total radiation dose. Cancer chemotherapy is provided as a primary treatment for some cancers and as an adjunctive modality for other cancers. The goal is to eradicate the rapidly growing cells of the tumor, but chemotherapy is often toxic to other cells that rapidly divide normally including the oral mucosa. The use of combined chemotherapy and radiation is now considered standard for most locally advanced tumors of the head and neck. The toxicities of this combined therapy are essentially the same as with radiation alone, but develop more rapidly and are typically more severe when they reach maximum level. The most common oral sequelae of cancer treatment are: xerostomia, the sensation of a dry mouth as a result of damage to the salivary glands and/or medication; mucositis, the inflammation and ulceration of the oral mucosa; and infection as a result of the loss of mucosal integrity. Management of oral health during cancer therapy includes identifying at-risk patients, patient education, appropriate pretreatment interventions, and timely management of complications. Appropriate preventive and therapeutic measures will help minimize the risk of oral and associated systemic complications, improve treatment outcomes, and improve the patient's quality of life.  相似文献   

13.
Patients with chronic myeloid leukaemia (CML) are at considerable risk of developing second primary neoplasms. However, mucosal squamous cell cancers (SCCs) of the head and neck have not been reported. We review the data of 7 patients with mucosal SCC of the head and neck that presented as metachronous second primary tumours in patients with CML. All 7 patients were men (median age 48 years, range 31-67) (site:oral cavity n=6, hypopharynx n=1). The median interval between diagnosis of CML and head neck cancer was 6 years (range 2-15). Treatment was curative in 4 and palliative in 3. At median follow up of 14 months (range 2-44), 3 patients had died of head and neck cancer, 1 of CML, and 3 were alive and free of disease. Mucosal cancers of the head and neck can occur in long-term survivors of CML. They are aggressive and tend to recur.  相似文献   

14.
目的 基于目前国内人乳头瘤病毒(HPV)相关的头颈肿瘤的文献,结合国外文献研究,分析目前我国在此领域的研究现状。方法 计算机检索四川大学图书馆电子期刊数据库,包括中国生物医学文献数据库(CBM)、维普中文科技期刊数据库(VIP)和万方期刊全文数据库,筛选并提取数据,分析国内与HPV相关的头颈肿瘤研究的基本特征、HPV总检出率以及不同临床病理指标对HPV感染的影响。结果 国内头颈肿瘤患者中,HPV总检出率为34.05%。在分析不同临床病理指标对口腔鳞癌患者HPV感染的影响时,不吸烟组、不饮酒组的HPV感染率高于吸烟组(P=0.002)、饮酒组(P<0.005);N2~N3期的HPV检出率高于N0~N1期(P=0.027)。结论 HPV相关头颈肿瘤的中文文献多数以临床研究为主,未来应继续研究致病的分子病理机制以及预后的分子信号通路,更多关注具有前瞻视角的治疗型HPV疫苗和分子靶向的研究。  相似文献   

15.
Radiation-induced salivary dysfunction: clinical course and significance   总被引:1,自引:0,他引:1  
Salivary gland dysfunction commonly occurs as a result of radiation therapy for cancers of the head and neck region. The effect of radiation on salivary glands is immediate and predictable. Histologic and sialochemical studies indicate both the acini and ducts are affected. The extent of salivary dysfunction is primarily determined by the radiation field and dose. Radiation-induced salivary dysfunction is permanent and leads to a host of clinical sequelae, both oral and systemic.  相似文献   

16.
Cancer of the oral cavity is fortunately rare in the Western world. However, rates are rising and are comparatively high in lower socioeconomic groups and in many metropolitan areas. Whenever possible, cancer of the oral cavity should be distinguished from "head and neck" cancers, because "site" is so important in the behavior of the disease. This review discusses the advantages and disadvantages of various methods of diagnosis, therapy, reconstruction, social rehabilitation, and pain control of oral cancer and of head and neck cancer.  相似文献   

17.
Skin cancer is the most common malignancy in man. The sun-exposed surfaces of the head and neck are the areas most frequently involved. Since skin cancers in most instances are easily recognized, they may be diagnosed at an early stage. The dentist may play a role in the early detection of skin cancers of the head and neck.  相似文献   

18.
An increasing number of reports indicate successful use of dental implants (DI) during oral rehabilitation for head and neck cancer patients undergoing tumor surgery and radiation therapy. Implant‐supported dentures are a viable option when patients cannot use conventional dentures due to adverse effects of radiation therapy, including oral dryness or fragile mucosa, in addition to compromised anatomy; however, negative effects of radiation, including osteoradionecrosis, are well documented in the literature, and early loss of implants in irradiated bone has been reported. There is currently no consensus concerning DI safety or clinical guidelines for their use in irradiated head and neck cancer patients. It is important for health care professionals to be aware of the multidimensional risk factors for these patients when planning oral rehabilitation with DIs, and to provide optimal treatment options and maximize the overall treatment outcome. This paper reviews and updates the impact of radiotherapy on DI survival and discusses clinical considerations for DI therapy in irradiated head and neck cancer patients.  相似文献   

19.
Nutrition and the head and neck cancer patient   总被引:4,自引:0,他引:4  
Patients with head and neck cancer have a unique nutritional problem that can affect their response to treatment. To properly manage these patients the oral and maxillofacial surgeon must be able to accurately assess their nutritional status and implement the proper metabolic treatment. This article reviews the benefits of nutritional support, the methods of patient assessment and nutritional repletion, and the advantages and disadvantages of the various alimentation modalities. Also, an analysis of the relationship of nutritional status and the surgical course of the head and neck cancer patient at our institution is presented.  相似文献   

20.
近年来免疫检查点抑制剂(ICIs)在恶性肿瘤治疗中有着突破性进展,并迅速被批准作为多系统恶性肿瘤的一线治疗方案。在头颈部鳞癌中,帕博利珠单抗单药或联合化疗方案已被国内外指南推荐用于复发/转移头颈部鳞癌的一线治疗。虽然ICIs在头颈部鳞癌治疗中有里程碑的意义,但当前仍然存在诸多需要重视的问题,如ICIs疗效预测因子的选择,肿瘤病灶对ICIs治疗反应的评价,免疫超进展的应对以及免疫相关不良反应的处理等。因此,本共识基于当前临床已有的循证医学依据,结合临床上关注的热点问题进行深入探讨,整合头颈部肿瘤各专业领域专家的临床工作经验而形成相对规范统一的认识。  相似文献   

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