Treatment of Multiple Primary Oral Squamous Cell Carcinomas with Surgery and Concurrent Chemoradiotherapy Followed by Future Custom-made Targeting Therapy-A Case Report

以手術切除同步併用化學放射療法與客製化標靶藥物治療多發性口腔癌－病例報告

賴義明(Yi-Ming Lai) ； 趙載光(Tai-Kuang Chao) ； 曾非凡(Fei-Fan Tseng) ； 陳元武(Yuan-Wu Chen)

《臺灣口腔顎面外科學會雜誌》 33卷2期 (2022/06) Pp. 125-136

摘要

Local tumor recurrence can be attributed to several adverse factors, such as human papilloma virus infection, cisplatin resistance, continuation of smoking, betel nut chewing, and insufficient margin distance with tumor biology. Recurrent head and neck cancers present with some of the most challenging management issues in oncological practice. Surgical treatment for local tumor recurrence seems to be the best option. The aim of surgical treatment is to remove the entire tumor with a wide and clear margin. Radiotherapy includes re-irradiation with intensity-modulated radiotherapy (IMRT) or biological therapies (epidermal growth factor receptor inhibitor). The chemotherapy recommendation for local recurrence is triple therapy with platinum, cetuximab, and 5-fluorouracil, which appears to provide the best outcomes. Here, we present the case of a 70-year-old patient who was diagnosed with recurrent oral squamous cell carcinoma and underwent tumor ablation surgery as well as neck lymph node dissection between 2016-2021. We performed right neck supraomohyoid neck dissection, main lesion excision, and marginal bone resection. To prevent cancer stem cell progression, drug sensitivity testing of circulating tumor cells (CTCs) was performed. The sensitivity test indicated the potential target therapy drug, which may be useful in blocking the growth of cancer cells. The individual application of CTCs in future tumor treatment is just around the corner.

關鍵字

Oral squamous cell carcinoma ； CCRT ； Recurrent head and neck cancer ； IMRT ； Circulating tumor cell

並列摘要

局部癌症復發常為多因素導致，如人類乳突病毒感染、鉑金類化療藥物抗性、菸癮及檳榔未戒斷、腫瘤切除時安全距離不足等。復發性腫瘤是癌症治療團隊艱難的挑戰，以外科手術方法切除復發腫瘤，並安排更足夠的手術安全距離是目前最佳療法。放射線癌症治療建議使用強度調控放射線治療並結合生物療法（對抗表皮生長因子受體）。化學藥物癌症治療建議多處方藥劑併用：包含鉑金類、爾必得舒注射液、5－氟尿嘧啶類，能提供較佳療效。本病例為70歲男性，診斷為反覆性的口腔癌復發，於近五年期間進行多次腫瘤與邊緣骨塊切除與頸部淋巴廓清手術。為了預防腫瘤進一步復發與侵襲，抽取病患周邊血，運用循環腫瘤細胞培養技術與化療藥物敏感測試，尋求最有腫瘤抑制潛力的標靶藥物。此法可提供未來運用於個人化的癌症治療。

並列關鍵字

口腔鱗狀上皮細胞癌 ； 放射化療治療 ； 復發性頭頸癌 ； 強度調控放射治療 ； 循環腫瘤細胞