应重视口腔颌面部恶性肿瘤的综合序列治疗

口腔颌面部恶性肿瘤约占全身恶性肿瘤的3％，虽然所占比例不高，但l大l其解剖部位特殊．涉及美观和重要的生理功能，冈此对患者机体和心理的影响不容忽视。早期（Ⅰ、Ⅱ期）口腔颌面部恶性肿瘤无论采用手术和（或）放射治疗，均能取得良好效果。但遗憾的是，大多数患者就诊时，已属局部一区域晚期（Ⅲ、Ⅳ期）。由于受到局部解剖和维持功能的限制，单纯通过扩大手术切除范围和改进现有手术技术，除能改善患者生存质量外，已无法提高此类患者的生存率，延长其生存时间。

Comprehensive and sequential therapy for oral and maxillofacial malignancies: An evolving concept and clinical significance

Oral and maxillofacial malignancies still remain significant health problems worldwide, the 5- year relativesurvival rate was 47.7% for oral squamous cell carcinoma and 64.7% for carcinomas of the major salivary glands accordingto NCDB reports. Successful management of these malignancies now requires a cooperative or multidisciplinary approachstrongly evidence based, ordered, even individualized rather than randomized, among a broad group of medical disciplinesincluding head and neck surgery, radiation oncology, medical oncology, medical imaging, clinical pathology and labmedicine, social work, nutrition, and others. Different treatment modalities are mandatory for different primary sites,histopathologic types, different TNM stages and different patients, either dominated by surgery, radiation therapy orchemotherapy, coordinated other modalities. This paper evaluated and summarized current comprehensive and sequentialapproaches to the management of oral and maxillofacial malignancies, emphasizing the importance of multidisciplinaryteam approach to coordinate surgery, radiation therapy and chemotherapy. The roles of induction chemotherapy andconcomitant chemoradiotherapy were also discussed. Comprehensive strategies for different oral and maxillofacialmalignancies had been proposed by National Comprehensive Cancer Network (NCCN) and introduced to the Chinesecolleagues for clinical references. The future lies in the development of individualized treatment regimes that combineearly detection with organ preservation and result in improved cure rates and quality of life, study of the best treatmentorder of the three disciplines of surgery, radiation, and chemotherapy; the refinement of radiation by altering fraction dose,sequence, and time course; radiosensitization by chemo- and biologic therapy; and the addition of novel, biologicallytargeted agents to these disciplines.