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头颈肿瘤治疗专家讲座.pptx

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头颈部肿瘤治疗头颈肿瘤治疗伎俩手术治疗手术治疗缺点头颈部肿瘤功效保全性治疗目治疗对象治疗模式Radiotherapy适应症治疗方法常规分割单纯放疗舌根癌治疗超分割放疗随机分组研究RTOG90-03,fractionationschedulesRTOG90-03,loco-regionalcontrolRTOG90-03,survivalPreoperativeRTRTOG73-03Preversuspost-operativeradiotherapyofresectablesquamouscellcarcinomaoftheheadandneck.11reportspublishedduring1965-91，evaluatingpre-vs.post-operativeRTgivenatcomparabledoselevels.2reportswereofprospective,randomisedandnineofretrospectivecomparisons.WennerbergActaOtolaryngol1995，115(4):465-74Theelevenstudiescomprised1,358patients(326inprospectivestudies).Thebulkoftheevidenceclearlysuggestspost-operativeloco-regionalcontroltobesuperiortopre-operativeRT.However,thisseemstobeoffsetbythesubsequentdevelopmentofdistantmetastasesormetachronoustumours.WennerbergActaOtolaryngol1995，115(4):465-74Chemotherapy理想放疗增敏剂化疗增敏理论基础放疗合并化疗惯用药品化疗与放射治疗结合方式诱导化疗+放疗治疗模式诱导化疗+放射治疗II期研究诱导化疗III期随机分组研究结论(1)诱导化疗加放疗无严重副作用。临床或病理CR，无病生存率显著高于未到达CR者。诱导化疗组缺点术后化疗+放疗或同时化放疗术后序贯化疗研究RTOG81-16RTOG83-22andIG0034结果结论术后同时放化疗法国III期随机分组试验结果结论Concurrentchemoradiotherapy头颈部肿瘤同时放化疗随机研究结果MaterialsandmethodsResultsResultsPrognosticfactorsConclusionPignonJPLancet63临床随机研究10741例病人67%病人死亡全部III期NPC在MDACC接收同时化放疗Treatment5yrsur5-FU和DDP增加4%5年总生存率诱导化疗和辅助化疗对生存率无影响。诱导化疗在器官保留为目标治疗中，对生存率无显著作用。同时放化疗可显著提升局部控制率和生存率。ConcurrentChemotherapyandRadiotherapyforOrganPreservationinAdvancedLaryngealCancerRTOG91-11PurposeRTOG91-11RTOG91-11入组条件LaryngealpreservationLocal-regionalcontrolDistancemetastasis-freesurvival放疗急性反应治疗毒副作用结论Choosingaconcomitantchemotherapyregimenforsquamouscellheadandneckcancer:AsystematicreviewofthepublishedliteraturewithsubgroupanalysisAcceleratedfractionationwithaconcomitantboostisbetterthanconventionalstandardfractionationschedules(RTOG93-03)TheresultsshowsthatinductionCThasnegativerole,adjuvantCTseemsnottoimprovesurvival.Concomitantchemoradiotherapyshowingconsiderablepromise.(RTOG91-11andFrench94-01,andPignon’smeta-analysis)Becausetheheterogeneityofclinicaltrails,forthegivenpatient,whatwecando?Howtochoosethechemothereapyregimen?Purp