Management of Recurrent Head and Neck Cancer Recent Progress and Future Directions
Management of Recurrent Head and Neck Cancer Recent Progress and Future Directions
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DOI：
10.2165/11592540-000000000-00000
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发表时间：
2011-01-01
期刊：
影响因子：
11.5
通讯作者：
Brockstein, Bruce E.
中科院分区：
文献类型：
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作者：
Brockstein, Bruce E.
尽管吸烟率有所下降，但美国头颈鳞状细胞癌 (SCCHN) 的发病率仍在上升。这种上升的主要原因是人乳头瘤病毒 (HPV) 引起的 SCCHN 发病率不断增加。 HPV相关SCCHN的治愈率很高，尽管发病率有所增加，但死亡率仍保持稳定。多达一半的 SCCHN 患者会出现复发。对于这些患者，第一个临床决定是复发是否可以治愈，或者是否无法治愈。对于那些被认为可能治愈的患者，将进行手术或放射治疗，或两者兼而有之。对于那些无法治愈的复发患者，目标是姑息治疗，并且根据复发类型和其他因素，平均生存期可能会延长 6-12 个月。几种化疗药物对 SCCHN 有效，最显着的是铂类化合物、紫杉烷类、氟尿嘧啶 (5-FU)、甲氨蝶呤和西妥昔单抗。大约 10-25% 的患者会对其中一种药物的治疗有反应。铂加紫杉烷、铂加 5-FU、三者组合或这些药物中的一种加西妥昔单抗等组合的缓解率较高。与单药治疗相比，联合化疗尚未被证明能延长生存期，但铂类和 5-FU 组合中添加西妥昔单抗除外。许多口服生物可利用的酪氨酸激酶抑制剂已经在 SCCHN 中进行了测试或正在进行试验。尚未证明这些药物比目前可用的药物更有效。对于正在接受积极治疗的复发患者，特别是那些不再适合或拒绝进一步治疗的患者，必须严格注意缓解疼痛、口腔和气道问题以及营养、言语、社会和心理问题。
The incidence of squamous cell carcinoma of the head and neck (SCCHN) is on the rise in the US despite a drop in cigarette smoking rates. Much of this rise is due to the increasing incidence of SCCHN attributable to human papillomavirus (HPV). HPV-related SCCHN has a high cure rate, which contributes to the stable death rates despite the increased incidence. Up to half of patients with SCCHN will develop recurrence. For these patients, the first clinical decision is whether the recurrence is potentially treatable for cure, or is incurable. For those deemed potentially curable, surgical or radiation-based therapies, or both, are undertaken. For those who have incurable recurrences, the goals are palliation and possibly prolongation of life average survivals are in the range of 6-12 months depending on the type of recurrence and other factors.Several chemotherapy drugs are active in SCCHN, most notably the platinum compounds, taxanes, fluorouracil (5-FU), methotrexate and cetuximab. Approximately 10-25% of patients will respond to treatment with one of these drugs. The response rate is higher for combinations such as a platinum plus a taxane, a platinum plus 5-FU, a combination of the three, or one of more of these drugs plus cetuximab. Combination chemotherapy has not been shown to prolong survival over single-agent therapy, with the exception of the addition of cetuximab to a platinum and 5-FU combination. A number of orally bioavailable tyrosine kinase inhibitors have been tested or are undergoing trials in SCCHN. None of these has as yet been shown to be more effective than the currently available drugs. For patients with recurrences who are undergoing active therapy, and especially for those for whom further therapy is no longer appropriate or is declined, strict attention is necessary to palliation of pain, oral and airway issues, and to nutrition, speech, and social and psychological issues.