口腔颌面肿瘤总论(二)课件

口腔颌面部肿瘤总论(二)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

combinedandsequentialtherapy

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(Radiationtherapy)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

(conservativefunctionalsurgery)修复性功能性外科

(reconstructivefunctionalsurgery)

防止医源播散无瘤原则切缘在正常组织内整块切除（enbloc）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TongueReconstructionMandibleReconstructionRadiationTherapy

Prof.Rontgen–Xray

Prof.MarieCurie

–RadiumelementDefinition–ionizingradiationComponentofmulti-modalitytherapyIncreasinguseforheadandneckcancer

PrincipleRadiationsensitive

Typesofradiationtherapy

Externalbeam(外照射)vs.Brachytherapy(腔内照射)CommoncomplicationsGeneralPrincipleBasis–ionizing(电离)particlesinteractwithcellularmoleculesDamagesDNAimpossibleforthecellstogrowDamagesbothcancerandnormalcells,thelatterareabletorepairthemselvesUsedto:CombinedorassinglemodalityTreatlocalizedtumorsTreatleukemiaandlymphomaRapidlydividingcellpopulationsarethemostsensitivetoradiation

tumors,epithelialcells,hemopoieticcells(造血细胞)RadiobiologyExternalbeamElectronlinearaccelerator直线加速器Gammarays(Co60)TopatientShieldedcontainerRadioactivesourcesFlexiblehoseCatheterRadioactivewireRadium“needles”AfterloadingBrachytherapyInternalradiotherapyTreatmentplansystemComplicationsAcuteTissueReactionsLateTissueReactionsAcuteToxicityMucosalreactions–2ndweekofXRT

MucositisSkinreactions–5thweekGenerallysubsideseveralweeksaftercompletionoftreatmentLateToxicityInjurytendstobepermanentDevelopwithinmonthstoyearsXerostomia(口干症),radionecrosisofbone,dentalcaries,fibrosis,soft-tissuenecrosis,nervetissuedamageChemotherapy

OneofthemaintechnologiesagainstcancerDefinitionNotcurative,usedonlyasanadjunctFirstappliedin1946Usedto:CurecancerControlcancerRelievesymptomscancercancauseUsuallyusedinadditionwiththeothertreatmentsCanbegiven:AthomeDr.’sofficeClinicOutpatientdept.AsaninpatientinahospitalClassificationofchemotherapydrugs

Chemicalstructure

cellcyclethedruginterrupts

Protocolofchemotherapy

monodrugandcombinationdrug

SideeffectofchemotherapyCellandTumorKineticsG1 synthesisRNAS DNAsynthesisG2 synthesisofmitoticspindleG0 restM mitosisChemotherapeuticAgentsAlkylatingagents(烷化剂)Antimetabolites(抗代谢类)AntitumorAntibiotics(抗生素)Steroidhormones(激素类)PlantAlkaloids(植物类)AlkylatingAgentsLinktoDNAbases–stopreplicationNitrogenMustards,HN2

Cyclophosphamide,CTXAntimetabolitesInhibitsynthesisofbasesMethotrexate5-FluorouracilAntitumorantibioticsPingyangmycinBleomycin

AdriamycinMitomycinActinomycinDHormonesPrednisoneEstrogenTestosteronePlantAlkaloidsDisruptmitoticspindleduringMphase

(cellcyclephasespecific)VincaAlkaloids

Camptothecins

TaxanesCellCycleCellCycleSpecificAgents

Antimetabolites

Bleomycin

PodophyllinAlkaloidsPlantAlkaloidsCellCycleNon-SpecificAgents

AlkylatingAgentsAntibioticsCisplatin

NitrosoureasChemotherapyProtocolOftencombinationofagentsDifferentmodesofactionReducedchanceofresistanceReducedtoxicityOftencombinedwithothertreatments(Adjuvant)PreReducetumourloadPostReducesub-clinicaldiseaseCombinationChemotherapy

moreeffectivethansingleagentadditiveantitumoreffectswithoutadditivehosttoxicitydelayedresistancetodrugsUseRapidlydividingtumoursmostsusceptibleBalancebetweenefficacyandtoxicitySideeffectofchemotherapymyelosuppression,lowbloodcellcountsgastrointestinaltractproblemshairlossskinrashesfatigueinfertilityErythema（红斑）HairytongueCandidiasis(念珠菌病)BiotherapiesorImmunotherapy

(免疫治疗)Cryotherapy

(低温治疗)LaserSurgery(激光外科)Thermotherapy(加热治疗)ChineseMedicine

(中医药治疗)GeneTherapy(基因治疗)Immunotherapy(active)Non-specificbacillusCalmette-Guerin(mycobacteria)

interferonsinterleukinsSpecifictumorcellvaccinesgenetherapyPassiveImmunotherapymonoclonalantibodiesLaserSurgeryNakedDNATargetCellTherapeuticProteinAAVRetrovirus/LentivirusAdenovirusNucleusGeneTherapyPrinciplesPreventionof

oral&maxillofacialtumor

Deletetheriskfactor

Treatmentofprecancerouslesion

Anticancerpropaganda

LeukoplakiaLichenplanusMelanosisoforalmucosa小结口腔颌面部肿瘤的治疗手段与地位口