Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Curr Opin Oncol. 2010 May;22(3):221-5. doi: 10.1097/CCO.0b013e32833818ff.
Survival gains were achieved in head and neck cancer patients treated with a multidisciplinary approach, including platinum-based concurrent chemoradiation, with a substantial increase in toxicity. The prompt diagnosis and treatment of these toxicities - the focus of this review - are essential aspects in the daily care of head and neck squamous cell carcinoma patients.
Low-level laser is a promising therapy for prevention and treatment of mucositis. Amifostine, as an acute and late xerostomia-preventive agent, may be considered in patients undergoing fractionated radiation therapy alone. The incidence of xerostomia was significantly reduced in patients treated with intensity-modulated radiation therapy. Severe cutaneous reactions can occur when epidermal growth factor receptor-targeting agents are administered concurrently to radiation therapy. Erythropoiesis-stimulating agents should not be administered to head and neck cancer patients under radiation therapy or chemotherapy outside of the context of clinical trials.
The best outcomes in head and neck squamous cell carcinoma patients treated in the multidisciplinary context can only be achieved with an adequate patient selection, an experienced and motivated team and if the best possible supportive care is offered. Randomized studies on promising supportive therapies must be encouraged.
采用多学科方法治疗头颈部癌症患者，包括铂类联合同期放化疗，取得了生存获益，但毒性也显著增加。及时诊断和治疗这些毒性反应——这是本综述的重点——是头颈部鳞状细胞癌患者日常护理的重要方面。
低水平激光是预防和治疗黏膜炎的有前途的治疗方法。氨磷汀作为一种急性和迟发性口干症预防剂，可考虑用于单独接受分割放疗的患者。调强放疗可显著降低口干症的发生率。表皮生长因子受体靶向药物与放疗同时使用时，可能会发生严重的皮肤反应。在临床试验以外的情况下，不应该对头颈部癌症患者在放疗或化疗期间给予促红细胞生成素刺激剂。
只有通过适当的患者选择、经验丰富和积极主动的团队以及提供尽可能好的支持治疗，才能对头颈部鳞状细胞癌患者在多学科环境下的治疗获得最佳结局。必须鼓励对头颈部癌症支持性治疗的有前途的治疗方法进行随机研究。
