Giusti Raffaele, Bossi Paolo, Mazzotta Marco, Filetti Marco, Iacono Daniela, Marchetti Paolo
Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy.
Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
Br J Pain. 2018 Aug;12(3):155-162. doi: 10.1177/2049463717736787. Epub 2017 Oct 10.
Head and neck (H&N) cancers account for about 5% of all malignant tumours. Pain is one of the most feared consequences of H&N neoplasms and is experienced by up to 80% of patients and worsens their quality of life inhibiting speaking, eating, drinking or swallowing. Nevertheless, pain is still often underestimated and undertreated.
The role of opioids in cancer pain has been well established but evidences about the role and the relative effectiveness of opioids such as fentanyl in the context of H&N cancer pain remains unclear.
A literature review based on the guidance of the Centre for Reviews and Dissemination was conducted. An iterative approach was used starting with an electronic search in the MEDLINE database. The search terms were used.
A total of 18 publications were found by the first performed search on PubMed. Other publications concordant with our aim were found by cross-reference. Considering inclusion and exclusion criteria for our review, eight papers resulted eligible for analysis.
Fentanyl transdermal therapeutic system (TTS) seems to be an important option, thanks to the way of administration, the good safety and tolerability profiles to control baseline pain. For breakthrough cancer pain (BTcP), several formulations of transmucosal fentanyl are available. All the formulations seem to be active and safety but we lack head-to-head studies of fentanyl versus other strong opioids, as well as with different formulation of fentanyl, particularly for BTcP where H&N cancer population is very poorly represented.
头颈部（H&N）癌症约占所有恶性肿瘤的5%。疼痛是H&N肿瘤最令人恐惧的后果之一，多达80%的患者会经历疼痛，这会降低他们的生活质量，抑制说话、进食、饮水或吞咽。然而，疼痛仍然常常被低估和治疗不足。
阿片类药物在癌症疼痛中的作用已得到充分证实，但关于芬太尼等阿片类药物在H&N癌症疼痛中的作用和相对有效性的证据仍不明确。
根据综述与传播中心的指南进行文献综述。采用迭代方法，首先在MEDLINE数据库中进行电子检索。使用了检索词。
在PubMed上首次进行的搜索共找到18篇出版物。通过交叉引用找到了其他与我们目标一致的出版物。根据我们综述的纳入和排除标准，有八篇论文符合分析条件。
芬太尼透皮治疗系统（TTS）似乎是一个重要的选择，这得益于其给药方式、良好的安全性和耐受性，可用于控制基线疼痛。对于爆发性癌痛（BTcP），有几种黏膜芬太尼制剂可供使用。所有制剂似乎都有效且安全，但我们缺乏芬太尼与其他强阿片类药物以及不同芬太尼制剂的直接对比研究，特别是在BTcP方面，H&N癌症患者群体的代表性非常差。
