口腔頜面部腫瘤總論(二)口腔頜面腫瘤的治療治療原則治療方法手術(shù)、放射治療、化療、生物治療、其它口腔頜面腫瘤的預(yù)防

口腔頜面部腫瘤的治療

治療原則綜合治療個(gè)體化方案（individualization）

因人因病量體裁衣

根治外科和功能外科并重良性腫瘤：手術(shù)治療惡性腫瘤：綜合序列治療

combinedandsequentialtherapy

化療＋手術(shù)＋放療＋其它

根據(jù)組織來源、細(xì)胞分化程度、腫瘤生長(zhǎng)部位、臨床分期(TNM)及全身情況選擇組織來源來源不同，治療方法不同上皮來源間葉來源淋巴造血系統(tǒng)骨肉瘤細(xì)胞分化

分化好—手術(shù)

分化差—放、化療生長(zhǎng)部位

顱底、深部、重要結(jié)構(gòu)—功能障礙

面部、皮膚、頜骨腫瘤—手術(shù)臨床分期早期晚期—綜合治療TNM分期(UICC)全身情況口腔頜面部腫瘤的治療方法手術(shù)治療(Surgery)

根治術(shù)與功能外科的概念，無瘤原則放射治療(Radiationtherapy)化療(Chemotherapy)生物治療(Biotherapy)

免疫治療(Immunotherapy)手術(shù)治療原則明確診斷明確手術(shù)作用，制定合理治療方案

診斷，探查，治愈，姑息，修復(fù)重建，預(yù)防

全面考慮，選擇合理術(shù)式保存性功能性外科

(conservativefunctionalsurgery)修復(fù)性功能性外科

(reconstructivefunctionalsurgery)

防止醫(yī)源播散無瘤原則切緣在正常組織內(nèi)整塊切除（enbloc）避免擠壓腫瘤表面紗布覆蓋使用電刀沖洗更換器械根治與功能并重TongueReconstructionMandibleReconstructionRadiationTherapy

Prof.Rontgen–Xray

Prof.MarieCurie

–RadiumelementDefinition–ionizingradiationComponentofmulti-modalitytherapyIncreasinguseforheadandneckcancer

PrincipleRadiationsensitive

Typesofradiationtherapy

Externalbeam(外照射)vs.Brachytherapy(腔內(nèi)照射)CommoncomplicationsGeneralPrincipleBasis–ionizing(電離)particlesinteractwithcellularmoleculesDamagesDNAimpossibleforthecellstogrowDamagesbothcancerandnormalcells,thelatterareabletorepairthemselvesUsedto:CombinedorassinglemodalityTreatlocalizedtumorsTreatleukemiaandlymphomaRapidlydividingcellpopulationsarethemostsensitivetoradiation

tumors,epithelialcells,hemopoieticcells(造血細(xì)胞)RadiobiologyExternalbeamElectronlinearaccelerator直線加速器Gammarays(Co60)TopatientShieldedcontainerRadioactivesourcesFlexiblehoseCatheterRadioactivewireRadium“needles”AfterloadingBrachytherapyInternalradiotherapyTreatmentplansystemComplicationsAcuteTissueReactionsLateTissueReactionsAcuteToxicityMucosalreactions–2ndweekofXRT

MucositisSkinreactions–5thweekGenerallysubsideseveralweeksaftercompletionoftreatmentLateToxicityInjurytendstobepermanentDevelopwithinmonthstoyearsXerostomia(口干癥),radionecrosisofbone,dentalcaries,fibrosis,soft-tissuenecrosis,nervetissuedamageChemotherapy

OneofthemaintechnologiesagainstcancerDefinitionNotcurative,usedonlyasanadjunctFirstappliedin1946Usedto:CurecancerControlcancerRelievesymptomscancercancauseUsuallyusedinadditionwiththeothertreatmentsCanbegiven:AthomeDr.’sofficeClinicOutpatientdept.AsaninpatientinahospitalClassificationofchemotherapydrugs

Chemicalstructure

cellcyclethedruginterrupts

Protocolofchemotherapy

monodrugandcombinationdrug

SideeffectofchemotherapyCellandTumorKineticsG1 synthesisRNAS DNAsynthesisG2 synthesisofmitoticspindleG0 restM mitosisChemotherapeuticAgentsAlkylatingagents(烷化劑)Antimetabolites(抗代謝類)AntitumorAntibiotics(抗生素)Steroidhormones(激素類)PlantAlkaloids(植物類)AlkylatingAgentsLinktoDNAbases–stopreplicationNitrogenMustards,HN2

Cyclophosphamide,CTXAntimetabolitesInhibitsynthesisofbasesMethotrexate5-FluorouracilAntitumorantibioticsPingyangmycinBleomycin

AdriamycinMitomycinActinomycinDHormonesPrednisoneEstrogenTestosteronePlantAlkaloidsDisruptmitoticspindleduringMphase

(cellcyclephasespecific)VincaAlkaloids

Camptothecins

TaxanesCellCycleCellCycleSpecificAgents

Antimetabolites

Bleomycin

PodophyllinAlkaloidsPlantAlkaloidsCellCycleNon-SpecificAgents

AlkylatingAgentsAntibioticsCisplatin

NitrosoureasChemotherapyProtocolOftencombinationofagentsDifferentmodesofactionReducedchanceofresistanceReducedtoxicityOftencombinedwithothertreatments(Adjuvant)PreReducetumourloadPostReducesub-clinicaldiseaseCombinationChemotherapy

moreeffectivethansingleagentadditiveantitumoreffectswithoutadditivehosttoxicitydelayedresistancetodrugsUseRapidlydividingtumoursmostsusceptibleBalancebetweenefficacyandtoxicitySideeffectofchemotherapymyelosuppression,lowbloodcellcountsgastrointestinaltractproblemshairlossskinrashesfatigueinfertilityErythema（紅斑）HairytongueCandidiasis(念珠菌病)BiotherapiesorImmunotherapy

(免疫治療)Cryotherapy

(低溫治療)LaserSurgery(激光外科)Thermotherapy(加熱治療)ChineseMedicine

(中醫(yī)藥治療)GeneTherapy(基因治療)Immunotherapy(active)Non-specificbacillusCalmette-Guerin(mycobacteria)

interferonsinterleukinsSpecifictumorcellvaccinesgenetherapyPassiveImmunotherapymonoclonalantibodiesLaserSurgeryNakedDNATargetCellTherapeuticProteinAAVRetrovirus/LentivirusAdenovirusNucleusGeneTherapyPrinciplesPreventionof

oral&maxillofacialtumor

Deletetheriskfactor

Treatmentofprecancerouslesion

Anticancerpropaganda

LeukoplakiaLichenplanusMelanosisoforalmucosa小結(jié)口腔頜面部腫瘤的治療手段與地位口