局部晚期头颈部鳞癌术后辅助治疗的进展

局部晚期头颈部鳞癌的术后辅助治疗在整个治疗中占有重要地位,方案的选择日益注重个体化.调强技术使放疗更精确和适形.术后应尽早开始放疗,超过6周降低局部控制率.综合治疗在11周内完成较好.PET指导勾画靶区的作用仍有待进一步研究和形成共识.术后同步放化疗可以提高高危患者的疗效,但未能明显减少远处转移的发生.分子靶向治疗(西妥昔单抗)的疗效已经在非术后临床试验中被证实.人乳头瘤病毒、表皮生长因子受体和抑癌基因p53是目前分子生物学研究的热点,有望成为寻找个体化治疗新途径的突破口.

Advancement of postoperative management of locally advanced head and neck squamous cell carcinoma

The postoperative management of locally advanced head and neck squamous cell carcinoma(HNSCC) plays an important role in the whole treatment of HNSCC.It is highly recommended that treatment should be tailored to every individual.IMRT provides conformal dose distribution to patients.Postoperative RT should be started as soon as possible.An interval(from operation to radiotherapy) longer than 6 weeks would decrease the local control rate.The overall treatment time should be less than 11 weeks.The function of PET in assisting target volume delineation remains to be explored and reached a consensus.Postoperative concurrent chemoradiotherapy can improve the outcomes of patients with high-risk factors.But this regimen could not reduce the rates of distant metastasis.The efficacy of cetuximab has been demonstrated in a non-postoperative clinical trial.The clinical trials testing its efficacy in postoperative setting are going on.HPV,EGFR and p53 gene are hot pursuit of research nowadays.They are promising outbreaks for new pathways in the individualized treatment guided by molecular biology.