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[上呼吸消化道肿瘤的复发]

[Recurrence of upper aerodigestive tract tumors].

作者信息

Martin Laurent, Zoubir Mustapha, Le Tourneau Christophe

机构信息

Centre Guillaume-Le-Conquérant, 61, rue Denfert-Rochereau, 76600 Le Havre, France.

Institut Curie, Département de recherche clinique, 26 rue d'Ulm, 75005 Paris, France.

出版信息

Bull Cancer. 2014 May 1;101(5):511-20. doi: 10.1684/bdc.2014.1970.

Abstract

Recurrences of tumours of the upper aerodigestive tract are frequent despite the improvement of the primary treatment and they limit the rate of survival long-term. They occur in patients with multiple co-morbidities, often associated with sequelae or side effects of earlier treatments. The salvage treatment will add a cumulative toxicity and therapeutic options are limited. The choice will go from curator to palliative treatment. The report benefit-risk must be assessed in each case depending on the terrain and prognostic factors that have been identified, such as performance status, the time between initial disease and the recurrence, the site and the stratification of the recurrence. In operable non-metastatic recurrence surgery remains the treatment of choice. Multimodal treatment involving surgery, radiation therapy and chemotherapy in this context is being evaluated. Non-operable tumors have long been considered only in a palliative context. The evaluation of detailed irradiation as bifractionnated radiotherapy combined with chemotherapy helped establish protocols allowing long-term survivals and consider these treatments as potentially curators. However, the toxicity of these treatments is important. That is why the technical innovations of the radiation and the development of new chemotherapeutic agents today offer opportunities remaining to assess. The use of irradiation targeted by intensity-modulated radiation therapy (IMRT), and stereotactic radiotherapy by decreasing the irradiated volume should decrease the toxicity. Generally better tolerated than conventional chemotherapy agents, targeted therapies also took their places associated with radiotherapy in the treatment of these patients already treated. Cetuximab was the first agent obtaining an indication. Other agents are being evaluated in metastatic recurrent tumors, including exploring the possibilities of radiopotentialisation nanoparticles and the inhibitors of apoptosis proteins.

摘要

尽管原发性治疗有所改善,但上呼吸道消化道肿瘤的复发仍很常见,并且限制了长期生存率。复发发生在患有多种合并症的患者中,这些合并症通常与早期治疗的后遗症或副作用相关。挽救性治疗会增加累积毒性,且治疗选择有限。治疗选择将从根治性治疗转向姑息性治疗。必须根据已确定的病情和预后因素(如体能状态、初始疾病与复发之间的时间、复发部位和分层),对每个病例的获益风险进行评估。对于可手术的非转移性复发,手术仍然是首选治疗方法。正在评估在这种情况下涉及手术、放疗和化疗的多模式治疗。长期以来,不可手术的肿瘤仅被视为姑息性治疗。对详细照射作为双分割放疗联合化疗的评估有助于制定方案,使患者能够长期存活,并将这些治疗视为潜在的根治性治疗。然而,这些治疗的毒性很大。这就是为什么如今放疗技术创新和新型化疗药物的开发提供了有待评估的机会。通过调强放射治疗(IMRT)进行靶向照射以及通过减少照射体积进行立体定向放射治疗,应能降低毒性。靶向治疗通常比传统化疗药物耐受性更好,在这些已接受治疗的患者的治疗中,靶向治疗也与放疗联合应用。西妥昔单抗是首个获得适应证的药物。其他药物正在转移性复发性肿瘤中进行评估,包括探索放射性增强纳米颗粒和凋亡蛋白抑制剂的可能性。

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