老年口腔鳞癌患者皮下埋植泵动脉灌注新辅助化疗的临床研究

目的探讨CF化疗方案(卡铂加氟尿嘧啶)和CPM化疗方案(卡铂加平阳霉素加甲氨蝶呤)分别对老年口腔鳞癌患者行动脉灌注新辅助化疗和常规静脉给药新辅助化疗的疗效和不良反应。方法114例T2～T4老年口腔鳞癌患者均完成2个新辅助化疗疗程,随机分为4组(Ⅰ～Ⅳ),Ⅰ组(25例),CPM方案静脉给药化疗;Ⅱ组(32例),CPM方案动脉灌注化疗;Ⅲ组(21例):CF方案静脉给药化疗;Ⅳ组(36例),CF方案动脉灌注化疗。比较各组化疗2个疗程后的疗效和不良反应。结果2个化疗疗程后,Ⅰ～Ⅳ组有效率分别为44.00%、71.88%、47.62%、75.00%,不良反应发生率分别为64.00%、43.75%、66.67%、45.83%,CF方案和CPM方案行动脉灌注化疗均比常规静脉给药化疗能增加疗效,降低不良反应(P<0.05)。结论CF和CPM化疗方案对老年口腔鳞癌患者行动脉灌注新辅助化疗能达到减毒增效的目的。     

头颈部肿瘤调强放疗联合手术和化疗的回顾性分析

目的:回顾性分析头颈部肿瘤调强放疗(IMRT)的长期随访结果和影响预后的因素。方法:136例初治头颈部肿瘤接受全程IMRT,48例(35.3%)联合化疗。手术联合放疗平均剂量62.14 Gy(50～73 Gy),根治性放疗平均剂量68.99 Gy(56.4～77 Gy)。结果:中位随访时间19个月,3年局控率、区域控制率、无远处转移生存率、无瘤生存率和总生存率分别为83.2%、93.2%、75.8%、66.4%、67.6%。多因素分析显示临床分期、治疗模式、放疗前有无贫血是影响患者生存率的独立预后因素。急性0、1、2、3级皮肤反应发生率分别为3.7%,71.3%,24.3%,0.7%;0、1、2、3、4级黏膜反应发生率分别为4.4%,22.8%,57.4%,14.7%,0.7%。治疗结束1年后1、2、3度口干发生率分别为21.3%、16.2%、0.7%。结论:IMRT联合手术和化疗治疗头颈部肿瘤可取得较好疗效,不良反应可以耐受。临床分期、治疗模式、放疗前有无贫血是影响生存的主要因素。     

超声热疗联合TPF化疗治疗19例老年晚期口腔鳞癌的疗效分析

目的: 观察超声热疗联合TPF化疗对老年晚期口腔鳞状细胞癌（OSCC）的疗效及安全性。方法: 对2017年1月—2020年1月在徐州市中心医院口腔科就诊的19例OSCC老年患者,给予TPF化疗,周期第1天—多西他赛（75 mg/m²）+顺铂（75 mg/m²）,周期第1~5天—5,Fu（750 mg/m²）;在化疗过程中做5次热疗,分别于化疗开始的第l、3、5、7、9天,超声热化疗共2个疗程,观察并评价效果。采用SPSS 20.0软件包进行统计学分析,利用Kaplan-Meire法计算生存率。结果: 根据实体瘤评价标准1.0版,对肿瘤的变化进行疗效评价,其中完全缓解3例,部分缓解10例,疾病稳定5例,疾病进展1例,总有效率为68.4%。中位随访时间为36个月（8~48个月）,2年内生存率为63.2%。不良反应主要表现为常规化疗反应,未见严重不良反应。结论: 超声热疗联合化疗对老年口腔鳞癌患者具有协同抗肿瘤作用,安全有效,有望成为肿瘤治疗的又一种选择。     

Neoadjuvant and adjuvant chemotherapy in the multidisciplinary treatment of oral cancer stage III or IV

We performed a retrospective analysis on the effect of initial induction chemotherapy with two courses of cisplatin (each course 120 mg/m² cisplatin on day 1, then 20 mg/m² bleomycin (alone) per day for 5 days with 4 weeks between courses) in 75 consecutive patients with advanced cancer of the oral cavity or lip. Further local therapy consisted of surgery or radiation, depending on tumour location. In 18 resected patients adjuvant chemotherapy was added. This consisted of carboplatin, 400 mg/m² on day 1 then ftorafur alone, 500 mg/m²/day for 30 consecutive days, repeated every month for 4 consecutive months.Among the patients treated in the neoadjuvant setting, complete response was observed in 10 out of 75 patients (13%), and partial response in a further 50 patients (67%) (partial plus complete rate 80%). Of all the patients, 43% in stage III and 26% in stage IV were long-term survivors. Improved survival was observed in surgical patients where adjuvant postoperative chemotherapy was added (P < 0.025).The main toxic effect was vomiting, observed in 71 patients. We noted a low rate of stomatitis (4%) and an important hearing loss (12%).Neoadjuvant and adjuvant cisplatin-based chemotherapy as part of a multidisciplinary approach have a high overall response rate and low toxicity, and should increase survival in cancer of the oral cavity or lip.     

Prognostic value of response to preoperative chemoradiotherapy and residual tumor grades in tongue carcinoma

OBJECTIVE: The purposes of the present study were to analyze our experience with preoperative chemoradiotherapy followed by surgery for advanced tongue carcinoma and to assess the prognostic value of response to preoperative therapy in these tumors.Study Design: Between May 1988 and December 1999, a total of 43 patients with advanced but potentially resectable squamous cell carcinoma of the tongue were candidates for this study. A minimum tumor size of 3 cm was required. The mean age was 59.8 years (range, 26-85 years); 13 cases were advanced stage II, 23 cases were stage III, and 7 cases were stage IV. All patients were treated preoperatively with cisplatin- or carboplatin-based chemotherapy in combination with simultaneous irradiation to a target volume of 40 Gy; 2-6 weeks later, they underwent curative surgery. Tumor regression rate, residual tumor grade, and histologic regression grade to the preoperative therapy were analyzed to determine their influence on the prognosis. RESULTS: With a median follow-up of 60.5 months, overall survival rates were 86.0% for all cases, 92.3% for stage II cases, 77.3% for stage III cases, and 100% for stage IV cases. The progression-free survival rates according to tumor regression rate were 33.3% for group 1 (< 50% tumor regression), 66.7% for group 2 (> or = 50% and < 75% regression), 100% for group 3 (> or = 75% and < 100% regression), and 96.0% for group 4 (complete regression). The higher the tumor regression rates, the higher the survival rates. When patients who achieved a regression rate of 75% or higher were compared with those who did not, there was a significant difference in survival (P < .0001). The factors of residual tumor grade and histologic regression grade also had good correlations with the prognosis (residual tumor grade, P =.0324; histologic regression grade, P < .0001). CONCLUSIONS: The findings of the present study suggest that response to preoperative chemoradiotherapy, such as tumor regression rate, residual tumor grade, and histologic regression grade, could be of prognostic value in patients with tongue carcinoma.     

Implant survival in mandibles of irradiated oral cancer patients

OBJECTIVE: The aim of this study was to analyze long-term implant survival in the mandible after radiotherapy and radical surgery in oral cancer patients. STUDY DESIGN: Between 1990 and 2003, 71 patients (15 females, 56 males; average age 57.8 years, range 16-84.1 years) were treated with dental implants after radiochemotherapy and ablative surgery of oral cancer. Radiation therapy was delivered in daily fractions of 2 Gy given on 25 days (total dose of 50 Gy). Oral defects were reconstructed microsurgically with jejunal, iliac crest or radial forearm grafts. Thereafter 316 dental implants were placed in the non-irradiated residual bone (84; 27%), irradiated residual bone (154; 49%) or grafted bone (78; 25%) at various intervals (mean interval 1.41 (+/- 1.01) years, range 0.34-6.35 years). RESULTS: The mean follow-up time after implant insertion was 5.42 (+/- 3.21) years (range 0.3-13.61 years). The overall 2-, 3-, 5-, and 8-year survival rates of all implants were 95%, 94%, 91% and 75%. Forty-four implants were lost in 21 patients during the observation period. Irradiation of the mandibular bone showed significantly (P = 0.0028) lower implant survival compared with non-irradiated mandibular bone. The 8-year survival rate in the non-irradiated residual bone (two loss), irradiated residual bone (29 loss) or grafted bone (13 loss) were 95%, 72% and 54%, respectively. Time of implantation after irradiation showed no statistically significant influence. Implant brand, length or diameter or the incidence of resective surgery on the mandible and gender of patients had no statistically significant influence on implant survival. CONCLUSION: Radiation therapy with 50 Gy was significantly related to shorter implant survival in mandibular bone. Survival was lowest in grafted bone. Time of implant placement had no statistically significant influence on survival under the conditions of this study. Although implant survival is lower in irradiated mandibles, implants significantly facilitate prosthodontic treatment and enhance outcome of oral rehabilitation in cancer patients.     

顺铂双路疗法在晚期口腔鳞癌治疗中的作用

目的 研究顺铂双路化疗在晚期口腔鳞癌治疗中的作用。方法 采用颈外动脉插管灌注顺铂、平阳霉素及５－氟脲嘧啶,同时静脉滴注硫代硫酸钠解毒的方法治疗晚期口腔鳞癌２３例,连续使用５－７ｄ为一疗程,顺铂的总剂量达１５０ｍｇ以上时进行疗效判断。结果 除１例因插管后出现暂时性肢瘫拒绝化疗,１例顺铂剂量不足１５０ｍｇ外,特效７例、显效１１例、无效３例（肿瘤缩小不足５０％）,总有效率８５．７％。除Ⅰ～Ⅱ级的胃肠道反     

口腔鳞癌新辅助化疗的回顾性研究

目的 :探讨新辅助化疗在口腔鳞癌治疗中的近期和远期临床效果。方法 :对 1990 2 0 0 0年我院住院治疗的36例新辅助化疗口腔鳞癌患者和 72例术前未作任何辅助治疗的口腔鳞癌患者作回顾性分析 ,对化疗后临床肿瘤退缩程度、生存率、术后复发和转移率作比较。其中新辅助化疗组患者术前接受一个疗程的VM方案化疗后进行手术。结果 :新辅助化疗后临床完全缓解 6例 ,有 18例部分缓解 ,总有效率 6 6 .7%。在平均 4 8个月 (6 12 0个月 )的随访中 ,新辅助化疗组 12例出现复发 (33.3% )、3例 (8.3% )转移、6例 (16 .6 % )死于肿瘤 ,对照组 4 8例复发 (6 6 .7% ) ,2 0例 (2 7.8% )转移、2 8例 (38.9% )死于肿瘤 .两组差别有显著意义 (P <0 .0 5 )。结论 :新辅助化疗安全低毒、不影响手术、近期肿瘤缓解率明显、远期可减少术后复发和转移率、大大提高患者无瘤生存率     

101例头颈部横纹肌肉瘤临床、病理及预后分析

目的 ：总结头颈部横纹肌肉瘤的临床病理特点及影响预后的因素。方法 ：对上海交通大学医学院附属第九人民医院2006—2013年收治的头颈部横纹肌肉瘤患者进行回顾性研究。收集患者的临床、影像、病理、治疗资料及随访记录,采用SPSS 22.0软件包对数据进行统计分析。结果：给定时间段内共纳入101例患者,75例获得随访。其中,男52例,女49例;18岁以下50例,18岁以上51例。口腔黏膜、腮腺和颅底是最常见的发病部位;多形型65例,胚胎型27例,腺泡型9例;IRSⅠ级44例,Ⅱ级39例,Ⅲ级18例。29例仅接受手术治疗,20例同时接受手术和化疗,10例接受手术和放疗,42例接受上述3种治疗。8例病理结果提示颈淋巴结阳性,无手术阳性切缘。5年无瘤生存率为41.3%,5年总体生存率为44.0%。结论：头颈部横纹肌肉瘤5年总体生存率和无瘤生存率较低,IRS分级和肿瘤部位是影响生存的主要因素。切缘阴性的根治性手术治疗对头颈部横纹肌肉瘤预后至关重要;放疗、化疗等辅助治疗可提高肿瘤局部控制率及总体生存率。     

Dental management of a pediatric patient with Burkitt lymphoma: a case report

Recent advancements in the field of cancer diagnosis and chemotherapy have led to higher rates of survival for children with malignant tumors. More than 75% of pediatric patients diagnosed with malignancies survive more than 5 years. These advancements have resulted in additional responsibilities for dental professionals to diagnose, evaluate, prevent, stabilize, and manage the oral and dental problems that can compromise the quality of life of these children. This case report highlights the importance of professional and self-administered oral prophylactic measures and patient compliance in the successful oral rehabilitation of a pediatric patient with Burkitt lymphoma.     

白蛋白支持治疗在老年口腔癌患者围手术期的应用：一项回顾性研究

目的回顾性分析围手术期使用白蛋白对老年口腔癌患者术后康复的影响。 方法选取2014年1月至2018年12月期间,在中山大学孙逸仙纪念医院口腔颌面外科行口腔癌根治并行皮瓣修复重建的老年患者（年龄>65岁）217例,按围手术期是否使用白蛋白分成两组：对照组（82例）和白蛋白组（135例）,对两组患者围手术期输血量、补液量、术后第3天血清白蛋白水平、术后局部和全身并发症的发生率及住院时间进行比较。采用SPSS 20.0软件包对数据进行统计学分析。 结果白蛋白组围手术期晶体液的输注量为（3753.8 ± 286.6） mL,较对照组[（4657.3 ± 326.8） mL]减少,差异有统计学意义（t = 98.3,P<0.001）;术后第3天白蛋白组血清白蛋白水平[（30.5 ± 4.3） g/L]较对照组[（26.6 ± 4.8） g/L]显著升高,差异有统计学意义（t = -4.04,P<0.001）;白蛋白组术后局部并发症的发生率为12.0%,较对照组（26.8%）显著降低,差异有统计学意义（χ² = 8.91,P = 0.003）;白蛋白组术后住院时间[（13.7 ± 4.9） d]较对照组[（16.5 ± 6.4） d]显著缩短,差异有统计学意义（t = 4.48,P<0.001）。 结论对于行口腔癌根治并行皮瓣修复重建的老年患者围手术期使用白蛋白支持治疗是一种有效的治疗方法,可降低术后并发症,缩短住院时间,加快患者的康复。     

Intraoral melanoma: long-term follow-up and implication for dental clinicians. A case report and literature review

Primary intraoral melanoma is a rare neoplasm with a poor prognosis, accounting for 1% to 8% of all melanoma in Europe and the United States. The incidence (12%) and 5-year survival rate (17.4%) are higher in Japan. We report a case of oral lentiginous melanoma in a Japanese-American man who survived disease-free for more than 5 years after surgery, radiation therapy, and chemotherapy but developed chronic mucositis of the palate under the denture in the primary radiated field. This lesion responded to antifungal therapy. Subsequent multiple biopsies ruled out the recurrence of melanoma but demonstrated prolonged melanocytic hyperplasia and focal epithelial atypia. We reviewed clinical differences in oral melanoma reported in the United States and Japanese literature, and describe the wide variety of oral clinical features of postoperative radiation and chemotherapy, as well as the oral tissue changes caused by denture-induced mucositis and candidiasis in such patients. Dental clinicians should conduct a thorough head, neck, and oral follow-up with increased vigilance in patients with a history of prior cancer.     

Surgical salvage for local and regional recurrence in oral cancer.

PURPOSE: To evaluate local and regional recurrence and the outcomes for salvage surgery in patients for oral cancer. PATIENTS AND METHODS: This study analyzed 354 consecutive patients with oral cancer treated primarily by surgery or surgery combined with adjuvant therapy by 1 surgeon (R.A.O.) between February 1991 and September 2001. RESULTS: Overall recurrence rate was 15.5%; with 5.4% local, 8.5% regional, and 1.4% locoregional. Overall salvage for local recurrence was 52.6% 3-year survival, and statistically significant favorable prognostic factors were salvaged by surgery alone and initial cancer staging of I/II. Overall salvage for regional recurrence was 50%, with recurrence in a previously untreated neck and salvage with radical neck dissection plus radiotherapy giving the best prognosis. No patients with locoregional recurrence were salvaged. CONCLUSIONS: Patients who were stage I/II and were treated initially by surgery alone were the best candidates for salvage if they recurred. Salvage was best achieved with surgery or surgery + adjuvant therapy, and patients recurring within 6 months had a worse survival. Patients with locoregional recurrence or treated with RT +/- chemotherapy alone have negligible survival.     

The clinical picture, diagnosis and radiation treatment principles in cancer of the buccal mucosa

Diagnosis and treatment of 228 patients with cancer of the buccal mucosa is analyzed. There were 130 women and 98 men aged 65 years on average. 218 were primary patients and 10 with relapses. Squamous-cell carcinomas with hornification predominated: 217 cases (95%). Adenocarcinoma was diagnosed in 8 (3.5%) and poorly differentiated cancer in 3 patients. Metastases to the regional lymph nodes were detected in 25% cases. For cosmetic reasons, radiotherapy (oral x-ray therapy, interstitial method, long-distance gamma beam therapy) was the method of choice.     

Extracapsular extension in oral cavity cancers—predictive factors and impact on recurrence pattern and survival

Extracapsular extension (ECE) has long been considered a poor prognostic factor in oral cavity cancer, the presence of which warrants intensification of adjuvant therapy. This study was done to analyze the survival of patients with ECE who received adjuvant chemoradiation. Patients with pathologically confirmed squamous cell carcinoma of the oral cavity, with a minimum of 2 years of follow-up, who were treated at a tertiary cancer centre in New Delhi, India during the years 2009–2017, were included. On multivariate analysis, ECE was significantly associated with depth of invasion >10 mm and tumour deposit size >5 mm. Among the node-positive group, patients without ECE had a 5-year disease-free survival (DFS) and 5-year overall survival (OS) advantage over ECE-positive patients of 7.8% (63.8% vs. 56.0%) and 16.5% (87.2% vs. 70.7%), respectively. For patients with ECE, the hazard ratio for DFS and OS was 1.3 (95% confidence interval 0.97–1.75, P = 0.078) and 2.30 (95% confidence interval 1.35–3.92, P = 0.002), respectively. ECE remains one of the strongest predictors of recurrence and survival in oral cancer patients, and despite aggressive adjuvant therapy, distant recurrence is still significantly high.     

Intraarterial chemotherapy as neoadjuvant treatment of oral cancer.

Neoadjuvant chemotherapy in patients with primary squamous cell carcinomas of the oral cavity should lead to high remission rates whilst having low morbidity. Efficacy can also be enhanced by treating small tumour stages. As part of a multi-modality therapy of all stages of primary oral cavity carcinoma, 103 patients were treated with neoadjuvant intraarterial (i.a.) chemotherapy. After regimen A with 100 mg/m2 i.a. cisplatin followed by 5 day continuous intravenous infusion of 5-fluorouracil (1 g/m2 per day) in 36 patients, an i.a. high pressure chemo-perfusion with a dose of 150 mg/m2 cisplatin was used with simultaneous intravenous infusion of 9 g/m2 sodium thiosulfate (regimen B, 67 patients). Subsequent treatment comprised radical surgery and simultaneous radiochemotherapy with docetaxel. Partial and complete remissions were found in 80.6% (regimen A) and 67.2% (regimen B) of cases, tumour growth was inhibited in 11.1% and 31.3%. Very low toxicity could be shown especially in regimen B. 66.7% and 74.6% of patients could be operated on radically. Survival rate was 61.1% (regimen A, 22.7 months of mean observation time) and 79.1% (regimen B, 8.4 months). Patients with high-grade remissions seemed to have a survival advantage. Neoadjuvant i.a. chemotherapy with cisplatin, especially in its high dose variant, is a practical therapeutic tool for the treatment of all stages of primary oral cavity carcinoma.     

术前诱导化疗与口腔鳞癌多药耐药基因表达关系的研究

目的 研究口腔鳞癌对不同给药途径的术前诱导化疗的疗效以及与多药耐药基因表达水平的关系。方法 将98例口腔鳞癌初诊患者随机分为3组:①术前未化疗组;②术前常规静脉给药化疗组;③术前动脉局部灌注化疗组,分别观察治疗疗效,并用免疫组化方法检测多药耐药基因编码的蛋白产物P-糖蛋白(P-gp)表达水平与术前化疗的关系。结果 动脉局部灌注化疗组疗效优于常规静脉给药化疗组(P<0.05),未行化疗组口腔鳞癌组织P-gp阳性率为42.3％,经术前诱导化疗后癌组织P-gp阳性率显著升高(P<0.05),但不同给药途径的术前诱导化疗对口腔鳞癌组织P-gp表达的影响无显著性差异(P>0.05)。结论 术前化疗后其残留口腔鳞癌细胞的P-gp表达增高,术后最好选择放疗或进行药敏试验后选择化疗药物。     

Current chemotherapy of head and neck cancer

This article reviews the results of over 50 published trials testing the use of chemotherapy in patients with squamous cell carcinoma of the head and neck. Among the trials using chemotherapy before standard surgery and/or radiotherapy in stage III and IV disease, none has shown an improvement in survival compared with surgery and/or radiotherapy alone. In these studies, the survival at 3 to 5 years has been generally 40% to 50%. Several trials using chemotherapy after standard therapy, however, have reported survival benefits of 10% to 20%, suggested that further evaluation of classic adjuvant chemotherapy in this disease is warranted. Among studies in recurrent head and neck cancer, the most effective chemotherapy regimens appear to be variations of the program consisting of cisplatin followed by a 5-day infusion of 5-fluorouracil. Nevertheless, median survivals in recurrent disease remain short, generally 5 to 10 months.     

Factors affecting survival in maxillary sinus cancer.

PURPOSE: The study goal was to determine survival parameters and clinical factors influencing survival for maxillary sinus malignancies. METHODS: Cases of maxillary sinus malignancy for the time period 1988 to 1998 were extracted from the Surveillance, Epidemiology and End Results database. Cases with distant metastatic disease at presentation were excluded. Clinical information, including tumor histology, grade and stage, and extent of surgery and radiation therapy, were determined. Kaplan-Meier survival and Cox proportional hazards analyses were conducted to determine the influence of these factors on overall survival. RESULTS: The study sample was composed of 650 patients with maxillary sinus cancer (mean age, 64 years; male-to-female ratio, 3:2). The most common histology was squamous cell carcinoma (61.7%), followed by adenoid cystic carcinoma (9.8%). The overall mean (median) survival was 52 months (25 months), and 77.5% and 7.4% of patients presented with advanced (T3/T4) disease or cervical metastasis, respectively. Radiation therapy was administered in 441 patients (67.9%) and significantly improved survival mainly for those with T4 lesions. On multivariate analysis, increasing age, T stage, N stage, and tumor grade independently predicted poorer survival, whereas gender did not. Adenoid cystic carcinoma exhibited a significantly improved overall survival (P <.001). CONCLUSIONS: Survival for patients with maxillary sinus cancer is determined not only by TNM staging but also by tumor histology and grade. TNM staging effectively stratifies patients according to survival. Radiation therapy significantly improves survival for those with T4 lesions.