1、口腔颌面部肿瘤总论(二),季 彤 上海第二医科大学 口腔医学院 附属第九人民医院 口腔颌面外科,口腔颌面肿瘤的治疗 治疗原则 治疗方法 手术、放射治疗 、化疗、生物治疗、其它 口腔颌面肿瘤的预防,口腔颌面部肿瘤的治疗,治疗原则 综合治疗 个体化方案（individualization） 因人因病 量体裁衣 根治外科和功能外科并重,良性肿瘤：手术治疗,恶性肿瘤：综合序列治疗 combined and sequential therapy化疗手术放疗其它 根据组织来源、细胞分化程度、肿瘤生长部位、临床分期(TNM)及全身情况选择,组织来源 来源不同，治疗方法不同 上皮来源 间叶来源 淋巴造血系统
2、骨肉瘤,细胞分化 分化好手术 分化差放、化疗 生长部位 颅底、深部、重要结构功能障碍 面部、皮肤、颌骨肿瘤手术,临床分期 早期 晚期综合治疗 TNM分期(UICC) 全身情况,口腔颌面部肿瘤的治疗方法,手术治疗(Surgery) 根治术与功能外科的概念，无瘤原则 放射治疗(Radiation therapy) 化疗(Chemotherapy) 生物治疗(Biotherapy)免疫治疗(Immunotherapy),手术治疗原则,明确诊断 明确手术作用，制定合理治疗方案诊断，探查，治愈，姑息，修复重建，预防 全面考虑，选择合理术式 保存性功能性外科(conservative functional
3、 surgery) 修复性功能性外科(reconstructive functional surgery),防止医源播散无瘤原则 切缘在正常组织内 整块切除（en bloc） 避免挤压 肿瘤表面纱布覆盖 使用电刀 冲洗更换器械 根治与功能并重,Tongue Reconstruction,Mandible Reconstruction,Radiation Therapy,Prof. Rontgen X rayProf. Marie Curie Radium element Definition ionizing radiation Component of multi-modality ther
4、apy Increasing use for head and neck cancer,Principle Radiation sensitive Types of radiation therapy External beam(外照射) vs. Brachytherapy(腔内照射) Common complications,General Principle,Basis ionizing(电离) particles interact with cellular molecules Damages DNAimpossible for the cells to grow Damages bot
5、h cancer and normal cells, the latter are able to repair themselves,Used to: Combined or as single modality Treat localized tumors Treat leukemia and lymphoma Rapidly dividing cell populations are the most sensitive to radiationtumors, epithelial cells, hemopoietic cells(造血细胞),Radiobiology,External
6、beam,Electron linear accelerator 直线加速器,Gamma rays(Co60),Radium “needles”,After loading,Brachytherapy Internal radiotherapy,Treatment plan system,Complications,Acute Tissue Reactions Late Tissue Reactions,Acute Toxicity,Mucosal reactions 2nd week of XRT Mucositis Skin reactions 5th week Generally sub
7、side several weeks after completion of treatment,Late Toxicity,Injury tends to be permanent Develop within months to years Xerostomia(口干症), radionecrosis of bone, dental caries, fibrosis, soft-tissue necrosis, nerve tissue damage,Chemotherapy,One of the main technologies against cancer Definition No
8、t curative, used only as an adjunct First applied in 1946,Used to: Cure cancer Control cancer Relieve symptoms cancer can cause Usually used in addition with the other treatments,Can be given: At home Dr.s office Clinic Outpatient dept. As an inpatient in a hospital,Classification of chemotherapy dr
9、ugs Chemical structure cell cycle the drug interrupts Protocol of chemotherapy mono drug and combination drug Side effect of chemotherapy,Cell and Tumor Kinetics G1 synthesis RNA S DNA synthesis G2 synthesis of mitotic spindle G0 rest M mitosis,Chemotherapeutic Agents,Alkylating agents(烷化剂) Antimeta
10、bolites(抗代谢类) Antitumor Antibiotics(抗生素) Steroid hormones(激素类) Plant Alkaloids(植物类),Alkylating Agents,Link to DNA bases stop replication Nitrogen Mustards, HN2Cyclophosphamide, CTX,Antimetabolites,Inhibit synthesis of bases Methotrexate 5-Fluorouracil,Antitumor antibiotics,Pingyangmycin Bleomycin Ad
11、riamycin Mitomycin Actinomycin D,Hormones,Prednisone Estrogen Testosterone,Plant Alkaloids,Disrupt mitotic spindle during M phase (cell cycle phase specific) Vinca Alkaloids Camptothecins Taxanes,Cell Cycle,Cell Cycle Specific AgentsAntimetabolites BleomycinPodophyllin AlkaloidsPlant Alkaloids,Cell
12、Cycle Non-Specific AgentsAlkylating AgentsAntibiotics CisplatinNitrosoureas,Chemotherapy Protocol,Often combination of agents Different modes of action Reduced chance of resistance Reduced toxicity Often combined with other treatments (Adjuvant) Pre Reduce tumour load Post Reduce sub-clinical diseas
13、e,Combination Chemotherapy more effective than single agent additive antitumor effects without additive host toxicity delayed resistance to drugs Use Rapidly dividing tumours most susceptible Balance between efficacy and toxicity,Side effect of chemotherapy,myelosuppression, low blood cell counts ga
14、strointestinal tract problems hair loss skin rashes fatigue infertility,Erythema（红斑）,Hairy tongue,Candidiasis(念珠菌病),Biotherapies or Immunotherapy (免疫治疗) Cryotherapy (低温治疗) Laser Surgery (激光外科) Thermotherapy (加热治疗) Chinese Medicine (中医药治疗) Gene Therapy(基因治疗),Immunotherapy (active) Non-specificbacillu
15、s Calmette-Guerin(mycobacteria)interferonsinterleukins Specific tumor cell vaccines gene therapy Passive Immunotherapy monoclonal antibodies,Laser Surgery,Naked DNA,Target Cell,Therapeutic Protein,AAV,Retrovirus/Lentivirus,Adenovirus,Nucleus,Gene Therapy Principles,Prevention of oral & maxillofacial
16、 tumor,Delete the risk factor Treatment of precancerous lesion Anticancer propaganda,Leukoplakia,Lichen planus,Melanosis of oral mucosa,小 结,口腔颌面部肿瘤的治疗手段与地位 口腔颌面部肿瘤的治疗方法的选择 “三早”原则,复习思考题,口腔颌面肿瘤的治疗原则及选择依据 什么是无瘤操作原则 化疗放疗及生物治疗的地位及适应证 如何加强口腔颌面肿瘤的预防,参考书目,口腔颌面外科理论与实践邱蔚六等，人民卫生出版社 口腔组织病理学吴奇光等，人民卫生出版社 口腔颌面外科临床手册邱慰六，张志愿主编，人民卫生出版社 口腔颌面肿瘤学张志愿主编，山东科技出版社,
