头颈癌患者生存质量的评价

头颈癌约占全身恶性肿瘤的５％。肿瘤根治性切除后可造成组织缺损畸形和功能障碍，可明显降低患者的生存质量（ｑｕａｌｉｔｙｏｆｌｉｆｅ，简称ＱＯＬ）。近２０年来，人们已经认识到ＱＯＬ评价应作为肿瘤临床研究不可缺少的重要部分，但对头颈癌患者ＱＯＬ评价的含义、内容与方法等报道较少，本文为了提高人们对头颈癌病人ＱＯＬ评价重要性的认识，除对ＱＯＬ含义、内容、评价方法等作一综述外，并对头颈癌患者ＱＯＬ评价常用的方法进行了比较，对其真实性和反应性加以评述。以利提高对头颈癌患者ＱＯＬ评价重要性的认识，并望能早日广泛应用于临床。     

1 头颈癌化疗的Meta分析——93组17346例患者随机实验最新资料

Meta-analysis of chemotherapy in head and neck cancer （MACH-NC）： An update on 93 randomised trials and 17,346 patients. Pignon JP, Maitre AL, Maillard E, et al. Radiother Oncol, 2009 May 14.     

晚期头颈癌化疗进展

对于无法手术治疗的晚期头颈鳞癌(HNSCC)患者,其治疗方法不断改善。其中最重要的治疗方法是放疗和化疗。目前,临床上对HNSCC主要采取顺铂为主的化疗联合同期放疗。然而,一些新的治疗方法包括针对表皮生长因子受体的靶向治疗和诱导化疗等已经在临床初步采用。该文旨在回顾诱导化疗在晚期HNSCC中的作用。     

头颈癌患者救治性再照射后的预后因素分析

头颈癌放疗后照射区域肿瘤复发或再发者预后差。再照射是治疗的选择之一,但其具有严重的毒性反应。该文旨在研究影响患者预后的潜在因素．包括伴发疾病及器官功能障碍对再照射后患者生存率的影响。对1998—2008年间的患者进行回顾性研究,察尔森合并症严重度指标评估伴发疾病．是否应用鼻饲及气管切开或软组织有无缺损界定口腔功能。结果：患者共103例,再照射前46例行救治性手术。肿瘤无进展平均时间为12．1个月,总生存率为19．3个月。36％的患者存在伴发疾病,     

头颈癌:恶性肿瘤治疗方法演进的范例

Head and neck cancer:an evolving treatment paradigm.Cognetti DM,Weber RS,Lai SY.Cancer,2008,113(7Suppl):1911-1932.自《癌症》杂志创刊以来,头颈癌的病因学及治疗方法发生显著变化。外科学、放疗及化疗的发展,提高了疾病的局部控制率、患者的生存率及其生存质量。     

PET和PET/CT在头颈癌中的应用

正电子发射断层扫描（PET）是一种功能性显像设备，是目前唯一可以了解组织分子生物学代谢改变的影像技术，临床研究已经证实其在恶性肿瘤的诊治中显示出了独特价值；但是由于PET缺乏解剖定位，临床应用仍受到一定限制；而PET／CT具有PET和CT的2种功能，实现了分子影像与解剖影像的同机融合，双方信息互补，彼此印证，进一步提高了诊断的特异性和准确性，自应用以来，受到学者们的普遍关注。本文就PET和PET／CT特别是PET／CT在头颈癌中的应用作一综述。     

头颈癌患者放疗期混合唾液质和量的变化

选择26例头颈部癌患者，对其放疗前、放疗中及放疗后刺激性混合唾液流率、乳铁素、溶菌酶、淀粉酶与白蛋白的含量进行分析，结果显示：唾液流率和淀粉酶含量在放疗开始后即明显下降，并一直维持在较低水平，半年后更低；唾液乳铁素、溶菌酶与白蛋白的含量在放疗早期明显升高，累积量达40Gy时稍有回落，当累积量达60Gy时，又明显升高，半年后基本恢复到治疗前水平。提示：唾液流率和淀粉酶含量的变化是反映放疗期唾液腺功能受损程度的可靠指标，而乳铁质、溶菌酶与白蛋白的变化是与放疗有关的炎症反应的指标。     

4 头颈癌患者血清中的预后标志物

Serum prognostic markers in head and neck cancer     

7核苷酸切除修复交叉互补集团1蛋白表达预测晚期头颈癌患者对诱导化疗的客观应答及生存率

该文旨在评价核苷酸切除修复交叉互补集团1（ERCC1）的表达与基于铂类诱导化疗的晚期头颈癌患者癌症生存专率的关系。对1992—1996年间的107例行诱导化疗的晚期头颈鳞癌患者进行研究．其中96例存在活检样本。对组织切片行ERCC1蛋白免疫组化染色，双盲法评价蛋白的表达。结果，68例（71％）存在ERCC1蛋白强阳性表达，28例（29％）为低表达。Logistic回归分析显示．蛋白低表达者对化疗的敏感性较高表达者高4倍（P=0．01）。     

同期化放疗治疗晚期头颈癌

头颈癌虽仅占成人恶性肿瘤的 5 % ,但其危害甚大。 1 995年 ,美国有新发头颈癌病人 3 975 0例 ,1 2 4 6 0例死于该病。早期头颈癌经手术和 (或 )放射治疗 ,多数可获治愈。但遗憾的是 ,大多数病人就诊时 ,已属局部 -区域晚期。过去 ,手术和 (或 )放疗被视为治疗局部 -区域晚期头颈癌的标准方法 ,但其治愈率不足 40 % ,远处转移率在 3 0 %以上。对于无法手术切除的病人 ,单纯放疗的局部复发率高达 5 0 % ,五年生存率不足 2 0 %。手术或放疗可导致广泛而严重的机体损害 ,包括畸形、功能损害和社交心理障碍 ;与单纯放疗相比 ,手术结合放疗对机体…     

头颈部骨肉瘤临床病理及预后分析

目的探讨头颈部骨肉瘤临床、病理特点和预后相关因素。方法回顾2007年1月1日—2013年12月31日于我科接受手术治疗的头颈部骨肉瘤患者的临床、病理学信息,应用SPSS17.0软件包对可随访患者的预后相关因素进行分析。结果最终收集160例头颈部骨肉瘤患者的临床、病理学信息,其中获得随访患者137例,5年总生存率为64.96%。与良好预后相关的因素为原发肿瘤、下颌骨肿瘤、阴性切缘、新辅助化疗以及辅助化疗的使用。结论完整切除肿瘤合并新辅助化疗、辅助化疗可以改善头颈部骨肉瘤患者的预后。     

ASA grade and disease-free mortality in head and neck cancer patients: A prospective study

Complex surgery with curative intent as part of the care of patients with head and neck cancer, who also have serious coexisting conditions is sometimes viewed critically as being unduly, optimistic. We have used American Society of Anesthesiologists’ (ASA) grading by a single anaesthetist prospectively as a baseline to investigate a possible link between coexisiting conditions and disease-free survival in 114 patients with head and neck cancer patients treated by the same anaesthetist and surgical team, and found that the ASA grade is not a reliable predictor of disease-free survival. There was no significant association between ASA grade and overall mortality, but there was a significant association between ASA grade and mortality associated with metastatic disease. However, the test for trend was not significant, which suggested that deaths from metastatic disease did not increase in line with ASA grading. All patients in ASA grades II and III were alive 2 years after their initial operation and the risk of mortality after 2 years may increase by up to 10%.     

Hypothyroidism after radiotherapy of head and neck cancer

AimHypothyroidism is not commonly considered as a complication of radiotherapy to the head and neck region. The purpose of this retrospective study was to determine the frequency of thyroid dysfunction in patients after radiotherapy, to compare thyroid hormone levels in irradiated patients with Control group and to predict development of thyroid hypofunction in time.Material and methodThyroid function was measured by means of thyroid stimulating hormone (TSH), free thyroxine (FT4) and free triiodthyronine (FT3) in 43 patients who had nonthyroid head–neck carcinomas treated by radiotherapy or radiotherapy in combination with other modalities. These data were compared with hormone levels of 40 Control group patients treated solely by surgery.ResultsHypothyroidism was found in 35% of irradiated patients. In comparison with Control group there were significant differences between TSH and FT4 levels, difference between FT3 levels was insignificant. A correlation between hormone levels and follow-up was detected.ConclusionOur results indicate that hypothyroidism is a frequent late side effect of radiotherapy to head and neck. Lifelong monitoring of thyroid function appears to be justified when radiotherapy is a part of treatment protocol.     

Prediction of post-treatment trismus in head and neck cancer patients

Our aim was to establish the incidence of trismus over time, together with risk factors (including quality of life (QoL)) for the prediction of trismus after treatment in patients with cancer of the head and neck. It was a longitudinal study of 152 patients accepted for primary operation who attended the head and neck cancer clinic of a tertiary referral cancer centre in the United Kingdom. A total of 87 patients was studied prospectively. Our results showed that 41/87 (47%) of patients presented with trismus, 57/80 (71%) had postoperative trismus, and 41/52 (79%) had trismus 6 months after operation or radiotherapy (trismus defined as a maximum mouth opening of ≤ 35 mm). Men and those who drank a lot of alcohol were less likely to have trismus after treatment. QoL variables showed that pain, eating, chewing, taste, saliva, social functioning, social contact, and dry mouth were significantly more impaired in the trismus group than among those without trismus. Postoperative differences in QoL between the two groups highlighted problems with social function and role-playing, fatigue, activity, recreation, and overall reduction in QoL. Women, and those who do not drink alcohol, are at particularly high risk of developing trismus, and, to prevent it and treat it, patients may benefit from multidisciplinary management at an early stage during treatment.     

Internet use among head and neck cancer survivors in the North West of England

In general, use of the internet by patients in their healthcare is increasing. However, its use specifically among those with head and neck cancer in the UK has not been reported. The aims of this study were to report access to the internet by survivors of head and neck cancer, to indicate where it fits within their information sources, how they have used it, and how they might use it in future. A question on its use has been included in annual surveys of patients since 2006. Patient-reported access to the internet increased from 32% in 2006 to 54% in 2010. There were considerable differences in access by age; currently (2010) 83% of those under 55 years, and 40% of those aged 65-84 years. Binary logistic regression modelling involving age at survey (p<0.001), age leaving education (p<0.001), and sex (p=0.01), gave all three as independent predictors of access. In the 2010 survey 49% (234/473) never used the internet, 10% (49/473) used it rarely, 15% (70/473) used it occasionally, and 25% (120/473) used it often. The main reasons for its use for head and neck cancer were to find information, learn about treatment, side effects, and medication, and obtain advice from members of multidisciplinary teams. The findings of this study show that the internet has an important role for patients in providing information and support about their cancer, although other sources are still very important. Data from the study will help inform those promoting e-health about the type of resource that is wanted by patients.     

经皮咽造瘘术20例临床分析

目的：探讨经皮咽造瘘术在头颈部肿瘤切除和重建手术后提供肠内营养的临床效果。方法：2012年1月一2012年7月．20例行头颈部手术的患者存我科接受经皮咽造瘘术,由经皮咽造瘘胃管提供肠内营养支持。收集每例患者的相关资料．包括患者信息、诊断、治疗方法、安放胃管时间及出现的并发症,对治疗效果和并发症进行分析。结果：所有患者均能耐受经皮咽造瘘口留置的胃管,无营养不良表现。留置胃管时间最短6d,最长84d,平均43．8d。在随访期内．1例患者的胃管意外脱山,2例患者的造瘘口渗出物较多,1例患者诉说胃管异物感比较明显,1例患者因反流性食管炎于术后第6天拔除胃管,其余患者均未发现明显的并发症。拔管后造瘘口可白行愈合,瘢痕小,不影响美观,、结论：经皮咽造瘘术是安全可行的,具有美观、舒适的优点,简便、经济,容易推广,并发症少,是一项值得推荐的肠内营养方法。     

多重PCR对头颈部肿瘤中MTS_1基因外显子2的检测分析

目的　为了解MTS1基因变异在头颈部肿瘤发生发展中的作用。方法　采用多重PCR技术扩增MTS1基因外显子 2。结果　本组MTS1基因外显子 2纯合子缺失的频率为 37.3 % (17/4 5 ) ,分化较好鳞癌MTS1基因缺失频率 31.5 % (6 /19)明显低于分化较差的鳞癌的 5 7.1% (8/14) ,但差异无显著性 (P >0 .0 5 )。结论　本研究提示MTS1基因变异与头颈部恶性肿瘤的发生发展有关     

头颈部癌放疗患者口腔念珠菌定植特征及分析

目的 了解头颈部癌(head and neck cancer,HNC)接受放射治疗患者临床分离口腔念珠菌的菌株定植特征,为临床防治方案的制定提供依据。方法 随机抽取60例HNC患者,于放疗前、放疗期间、放疗结束采用口腔含漱法取样,CHROMagar显色培养基、API 20C AUX 酵母菌鉴定系统进行分离培养鉴定,比较2组念珠菌的检出率和不同念珠菌种的检出量的差异。采用SPSS 17.0软件包进行统计学处理。结果 60例HNC放疗患者中,54例出现口干和吞咽困难,50例产生放射性口腔黏膜炎（radiation-induced oral mucositis,RIOM）,18例感染口腔念珠菌病;60例HNC放疗患者放疗期间和放疗结束口腔念珠菌的检出率分别为56.7%和63.3%,较放疗前（26.7%）明显升高,具有显著差异(χ²=18.320,P<0.001);54例临床分离株以白念菌为主（n=42）,其次是近平滑念珠菌（n=6）、热带念珠菌（n=4）和光滑念珠菌（n=2）;放疗患者口腔念珠菌致病菌的检出率量为30%,定植菌占46.7%。结论 HNC放疗患者口腔念珠菌的定植率明显升高,念珠菌感染可能是RIOM发生的重要原因。     

头颈鳞癌诱导化疗的评价与展望

头颈部鳞癌对化学治疗相对敏感，虽然经过近30年的临床研究，诱导化疗在头颈鳞癌中的应用价值仍然颇具争议。最近，随着晚期头颈鳞癌的治疗进展以及更有效的诱导化疗方案的出现，越来越多的证据显示出诱导化疗在头颈鳞癌治疗方面的价值。本文通过对以往临床试验资料的回顾和总结，探讨了诱导化疗在头颈鳞癌方面的治疗价值及发展方向。