Bumpous Jeffrey M
Department of Surgery, Division of Otolaryngology, University of Louisville School of Medicine, James Graham Brown Cancer Center, Louisville, KY 40292, USA.
Curr Oncol Rep. 2009 Mar;11(2):151-5. doi: 10.1007/s11912-009-0022-6.
Advanced oropharyngeal squamous cell carcinoma is treated primarily with chemoradiation, with the goal of excellent disease control and preservation of swallowing and articulation functions of the oropharynx. Disease control rates generally are excellent; however, a significant number of patients do not achieve locoregional control of disease. The importance of human papillomavirus expression in predicting successful tumor response, locoregional control, and survival following chemoradiation is increasingly confirmed. Emerging is a clinical profile, viral expression, and genetic expression pattern that can predict success of chemoradiation and indicate which patients are at higher risk for locoregional failure necessitating surgical salvage. Successful surgical salvage depends on restaging at the time of recurrence and the time interval from chemoradiation to recurrence. Although surgical morbidity and mortality remain a challenge in patients undergoing salvage surgery of the oropharynx after radiation failure with or without chemotherapy, they may be mitigated by liberal application of regional and microvascular free flap reconstruction techniques.
晚期口咽鳞状细胞癌主要采用放化疗进行治疗，目标是实现良好的疾病控制，并保留口咽的吞咽和发音功能。疾病控制率总体良好；然而，相当数量的患者未能实现疾病的局部区域控制。人乳头瘤病毒表达在预测放化疗后肿瘤反应成功、局部区域控制和生存方面的重要性日益得到证实。一种能够预测放化疗成功并表明哪些患者发生局部区域失败而需要手术挽救风险较高的临床特征、病毒表达和基因表达模式正在显现。成功的手术挽救取决于复发时的重新分期以及从放化疗到复发的时间间隔。尽管对于放疗失败后无论是否接受化疗而接受口咽挽救手术的患者，手术并发症和死亡率仍然是一个挑战，但通过广泛应用区域和微血管游离皮瓣重建技术，这些情况可能会得到缓解。
