读《放疗在头颈部癌临床治疗中的作用》后感

我们认真拜读了贵刊2005第40卷第11期继续教育园地栏目中发表的《放疗在头颈部癌临床治疗中的作用》文章后（以下简称“文章”）,使我们对鼻咽癌治疗有了新的看法.     

头颈部癌放疗的新进展

头颈部癌占所有恶性肿瘤的3％，美国每年新增病例约4万。头颈部癌患的治疗应该由受过多重训练的学科队伍负责，这支队伍中成员不仅能够提供有远见的治疗方案，还能给予口腔护理，以及营养、心理和社会学的支持。多重治疗的目标是最大限度地延长无瘤生存期和总的生存期，而死亡率降至最低。本综述头颈部癌的放疗技术和方案及近几年来的进展。     

带血管蒂肌皮瓣在头颈部根治性放疗后复发癌切除中的应用

目的：探讨带血管蒂肌皮瓣在头颈部根治放疗后复发癌手术中的应用。方法：对66例头颈部根治放疗后复发癌病人施行手术。其中60例应用了带血管蒂肌皮瓣，应用皮瓣有胸大肌肌皮瓣，斜方肌肌皮瓣，背阔肌肌皮瓣。胸三角肌皮瓣及额部皮瓣。结果：60例病人的3年生存率和5年生存率分别为68.3%和51.7%。有4例喉癌术后病人合并巨大咽瘘，其余生存质量均得到了改善，结论：根治性放疗后复发癌病人，局部血液循环差，头颈部重要生命血管表浅，应用带血管蒂肌皮瓣的目的不仅仅是为了修复局部缺损，更重要的是改善局部血液循环，以利于创口愈合，提高病人生存质量。     

不同治疗方式对头颈部癌患者生存质量影响的研究

目的调查不同治疗方法对头颈部癌患者近期生存质量的影响。方法将初次治疗的头颈部癌患 者分为手术前诱导化疗组和手术治疗组,参照欧洲肿瘤治疗与研究组织的生存质量核心问题及头颈部癌模 型,结合本地区情况,制订问卷调查表,对120例患者于治疗前后进行问卷调查。结果手术前诱导化疗后, 患者的生存质量有明显的改善,手术后部分生存质量指标改善,部分指标无改变。结论生存质量问卷调查 是一种易行敏感的评价头颈部癌患者治疗方式的方法,头颈部癌患者化疗后短期生存质量得到改善。     

头颈部癌肉瘤14例临床分析

目的:探讨头颈部癌肉瘤的病理学特点、治疗及预后。方法:回顾性分析2010年1月至2020年5月郑州大学第一附属医院收治的14例头颈部癌肉瘤患者的临床资料,其中男11例,女3例,年龄30~72岁。总结病理学特点、治疗以及随访情况。应用Kaplan-Meier法估计14例患者累积生存率。结果:所有患者病理组织学检查见恶性上...     

紫杉醇在头颈部鳞状细胞癌中的应用

头颈部鳞状细胞癌(SCCFIN)是世界范围内一个严重的问题,据调查,口腔及咽腔的肿瘤其发病率在世界范围内排名第6,每年大约有400万个新发病例,特别是在发展中国家成为男性第3常见癌症,其中大约有75％患者为Ⅲ一Ⅳ期M0的局部进展型。对于Ⅰ-Ⅱ期SCCHN患者目前多采用手术或放射治疗,Ⅲ-Ⅳ期局部进展型的患者目前多采用综合治疗方法。     

头颈部肉瘤样癌17例临床分析

目的:探讨头颈部肉瘤样癌的病理学特征、治疗及预后.方法:回顾性分析2013年9月-2020年9月郑州大学第一附属医院收治的17例头颈部肉瘤样癌患者的临床资料,总结其病理学特性、治疗方式及随访情况,应用Kaplan-Meier法计算其总的生存率.结果:所有患者病理组织学检查可见癌成分和肉瘤成分并存,两者之间存在过渡移行区...     

循环肿瘤细胞在头颈部肿瘤诊断中的临床作用

肿瘤转移和重要器官功能的丧失是头颈部肿瘤患者主要的死亡原因之一。寻找一种比目前常用的方法能更早期且更可靠的确定肿瘤转移和复发,可以改善治疗和预后。已确定循环肿瘤细胞在一些实体瘤中的监测转移及预后中起重要作用,检测肿瘤患者特别是高风险局部复发或远处转移的患者血液循环中的肿瘤细胞具有重要意义。本文就头颈部肿瘤相关肿瘤循环细胞最新研究进展做一综述。     

Synchronous VBM and radiotherapy in the treatment of squamous cell carcinoma of the head and neck.

Since April 1974, 60 patients with squamous cell carcinoma of the head and neck region, of poor prognosis and generally in advanced stages, were treated with the combination of a cytotoxic regimen--VBM (Vincristine, Bleomycin and Methotrexate) and radical radiotherapy. The essential feature of the combination is the administration of pulses of VBM synchronous with a course of fractionated external radiotherapy in order to achieve potentiation of radiotherapy. On average 4-5 pulses of VBM were given during treatment, combined with radiotherapy on a Cobalt unit. The selection, preparation and management of the patients are described. Intense mucositis and intercurrent infection provide the main problems during treatment and close management is essential. Late complications have not been a serious problem. The crude actuarial survival rate at 24 months is 61%. The probability of survival without any recurrence to 24 months following initial treatment is 46%. Local control was achieved by the initial treatment in 43 patients. These results suggest that potentiation of radiotherapy and an increased therapeutic ratio has been obtained by the addition of VBM to radiotherapy and there is a possibility that the occurrence of distant metastases has been reduced or postponed.     

Elective radiotherapy of the neck in patients with squamous cell carcinoma of the head and neck.

A prospectively recorded 5-year series of 254 patients receiving elective neck irradiation is evaluated. All had clinically negative necks and initial control at the primary site. Forty-seven percent of the patients had T3-4 tumours. Radiotherapy was delivered from a megavolt source at 2 Gy/day 5 days a week to a total dose of 46-50 Gy. All but 3 patients completed the treatment as planned. Neither tumour stage nor site of the primary tumour was related to the incidence of regional recurrences. Of 30 patients receiving 46-49 Gy, 5 died from neck node recurrences. Of 221 patients treated to 50 Gy or more, 16 (7.2%) developed regional recurrences. Two of these recurrences were avoided, giving a regional failure rate of 6.3%. As a whole, 7.8% died from regional, 11.4% from local, and 3.1% from distant recurrences.     

Combined modality treatment with full-dose chemotherapy and concomitant boost radiotherapy for advanced head and neck carcinoma

The purpose of this study was to evaluate the feasibility and efficacy of a treatment concept combining three cycles of full-dose chemotherapy (CT) with concomitant accelerated uninterrupted radiotherapy (RT). Twenty-three patients (median age: 54 years, range: 35–70) with locally advanced squamous cell carcinoma of the head and neck (SCCHN) were included. The primary tumor involved the hypopharynx (n=7), base of the tongue (n=10), nasopharynx (n=2) or upper esophagus (n=1) or its location was unknown (n=3). Treatment consisted of three cycles of chemotherapy (cisplatin 100 mg/m² on day 1; 5-FU 1,000 mg/m² per day for 5 days as a continuous infusion, preceded by amifostine 910 mg/m²), repeated every 3 weeks. Uninterrupted concomitant boost-accelerated RT (total dose of 70 Gy in 6 weeks) started together on day 1 of the second cycle. All but two patients received the full course of RT. Eighteen patients achieved complete remission (78%). At a median follow-up of 45 months the overall survival was 56% (95% c.i. 32–79%) and the loco-regional control 71% (95% c.i. 52–91%). Toxicity involved reversible renal insufficiency of grade II in 9 patients (39%) and neutropenic fever in 9 patients (39%). All patients suffered from moderate to severe mucositis (grade II/III), and 19 patients presented cutaneous toxicity grade III. Concomitant boost-accelerated RT combined with concurrent full-dose cisplatin/5-FU chemotherapy and amifostine is feasible with manageable, although substantial, toxicity. The overall survival of 4 years is promising. Newer regimens causing less acute mucosal and skin toxicity are needed.     

Control of neck nodes in squamous cell carcinoma of the head and neck by radiotherapy: prognostic factors

313 patients with cervical metastases from a squamous carcinoma of the head and neck treated with radiotherapy, were studied by means of a multivariant analysis in order to determine the prognostic factors for cure. These were: lymph node response to irradiation (P= 0.0000), size of node (P= 0.0000), radiotherapy dose (P= 0.0037), condition of the primary (controlled vs non-controlled) (P= 0.0015), recurrent cervical metastases post-surgery (P= 0.0286).     

Radiotherapy in the treatment of verrucous carcinoma of the head and neck

Because of reports of anaplastic transformation following irradiation, this study examines the incidence of anaplastic transformation and local control of these lesions. This review of seven patients who had verrucous carcinoma of the head and neck that was treated with irradiation shows local control in 71% of cases. There were no cases of anaplastic transformation. This report adds to the literature two cases of “de-differentiation” to less differentiated squamous carcinomas; one such case occurred after surgery alone. The literature is reviewed. Overall, anaplastic transformation is reported in 7% of patients who had irradiation. De-differentiation occurs after surgery as well. The rate of local control with irradiation is less than 50%; with surgery it is 85%. It is concluded that surgery should be used if the procedure has acceptable morbidity. Otherwise, irradiation can be used. Failures can be salvaged surgically. “Anaplastic transformation” should not affect treatment approach.