目的:日本头颈癌学会临床实践指南委员会于2013年对《日本头颈癌临床实践指南》进行了第一次修订,针对TNM分类的修订。
方法:新采用34CQs(临床问题)来描述目前认为最合适的诊断和治疗方法,并由委员会协商一致提供推荐等级。使用PubMed对2001年至2012年之间发表的研究进行了全面的文献检索。对合格的研究进行了分析,并对结果进行了评估,由所有委员会成员合并和编纂。
结果:选择性颈淋巴结清扫术(ND)确实有助于提高生存率,应该对高风险舌癌患者进行。目前,尚无研究明确证明超选择性动脉灌注化疗的实用性.然而,根据癌症的部位和阶段,联合放疗可能有助于保持器官功能或提高生存率。CDDP同步化疗和辅助放疗有助于提高晚期头颈部鳞状细胞癌复发高危患者的生存率。抗EGFR抗体西妥昔单抗(Cmab)与放射疗法具有累加效应。然而,必须仔细考虑适应症,因为该治疗方法尚未与放化疗的标准治疗方法进行比较.Cmab已被证明对不可切除的转移性或复发性癌症患者具有化学疗法(CDDP/5-FU)的累加作用。术前和术后口腔护理可以降低术后并发症的风险,例如头颈部癌症的手术伤口感染和肺炎。建议在ND后不久进行颈部淋巴结转移的康复,以维持和恢复肩关节功能。
结论:在本文中,我们描述了日本头颈部癌诊断和治疗最相关的指南和CQs.这些指南并非旨在管理此处未显示的疗法,而是旨在作为为个体患者寻找最合适治疗的指南。
OBJECTIVE: The first revision of \"Japanese Clinical Practice Guideline for Head and Neck Cancer\" was made in 2013 by the clinical practice guideline committee of Japan Society for Head and Neck Cancer, in response to the revision of the TNM classification.
METHODS: 34 CQs (Clinical Questions) were newly adopted to describe the diagnosis and treatment methods currently considered most appropriate, and offered recommendation grade made by the consensus of the committee. A comprehensive literature search was performed for studies published between 2001 and 2012 using PubMed. Qualified studies were analyzed and the results were evaluated, consolidated and codified by all the committee members.
RESULTS: Elective neck dissection (ND) does contribute to improvement in survival and should be performed for patients with high-risk tongue cancer. At present, no research has clearly demonstrated the utility of superselective arterial infusion chemotherapy. However, depending on the site and stage of the cancer, combination with radiotherapy may be useful for preserving organ function or improving survival rate. Concurrent CDDP chemotherapy and adjuvant radiotherapy contributes to improvement of survival rate as an adjuvant therapy for advanced squamous cell carcinoma of the head and neck in patients at high risk of recurrence. The anti-EGFR antibody cetuximab (Cmab) has an additive effect with radiotherapy. However, the indication must be carefully considered since this treatment has not been compared with the standard treatment of chemoradiotherapy. Cmab has been shown to have an additive effect with chemotherapy (CDDP/5-FU) in patients with unresectable metastatic or recurrent cancer. Preoperative and postoperative oral care may reduce the risk of postoperative complications such as surgical wound infection and pneumonia in head and neck cancers. Rehabilitation soon after ND for cervical lymph node metastasis is recommended for maintaining and restoring shoulder function.
CONCLUSIONS: In this article, we described most relevant guidelines and CQs for the diagnosis and treatment of head and neck cancer in Japan. These guidelines are not intended to govern therapies that are not shown here, but rather aim to be used as a guide in searching for the most appropriate treatment for individual patient.