頭頸部鱗狀細胞癌治療的新進展

Recent Advances and New Standards of Care for Patients with Head and Neck Squamous Cell Carcinoma

王宏銘(Hung-Ming Wang) ； 廖俊達(Chun-Ta Liao) ； 范網行(Kang-Hsing Fan) ； 吳樹鏗(Shu-Hang Ng) ； 詹勝傑(Sheng-Cheh Chan) ； 閣紫宸(Tzu-Chen Yen)

《腫瘤護理雜誌》 9卷S期 (2009/12) Pp. 51-67

https://doi.org/10.6880/TJON.200912/SP_9.05

摘要

抽菸、喝酒、特別是嚼檳榔的文化，使台灣地區口腔癌（包含口腔癌、下咽癌、口咽癌）發生率已佔所有癌症發生率的第六位。而口腔癌現在已經是男性癌症死亡率的第四位，每十萬人口有17.9人，死亡率高於鄰境的國家。除此之外，口腔癌更是台灣地區25~44歲年齡層的男性癌症發生率的第二位。而這個年紀的男性正是一個家庭結構與經濟的重要支柱，所以一個病患就是一個家庭的沉重負擔，此顯示出口腔癌在國內所造成的嚴重社會問題。頭頸癌的病患就診時多已為晚期，治療往往需要多科協同治療(multidisciplinaryteam work)。但現況除治療效果尚未臻理想外，治療本身不管是手術或放射線治療，往往會帶給病患在治癒後顏面外觀、吞嚥、嚼食、言語等功能的改變，進而影響病患的家庭社會生活。因此如何更精準的評估病患的預後，以給予適當、不「過與不及」的治療，並發展更精確有效、更少副作用的治療方式，乃是這幾年來醫界努力的方向。因此，我們將近年來頭頸癌治療的新進展，分成(1)人類乳突狀病毒(humanpapilloma virus, HPV)與頭頸癌的關係、(2)更精確影像學，如正子掃描搭配電腦斷層(3)本土頭頸癌病患手術後預後因子的確認與團隊合作治療(4)放射線治療的新進展(5)化學治療在頭頸癌治療的角色應用(6)頭頸癌的標靶治療等，以這些面向，期讓讀者們認識此些頭頸癌的治療進展，搭配多科協同治療的模式(multidisciplinary teamwork)，提供病患更少副作用，更佳的治療效果，以達到目前醫學界亟於努力之個人化癌症治療(personalized cancer therapy)的目標。

關鍵字

頭頸癌 ； 口腔癌 ； 檳榔 ； 人類乳突狀病毒 ； 正子掃描 ； 標靶治療

並列摘要

The incidence of oral cancer (including cancer of oral cavity, oropharynx, and hypopharynx) is the 6th of all cancers in Taiwan. This is closely related to the habit of smoking, alcohol drinking, and betel nut chewing. The death rate of oral cancer among male Taiwanese is 17.9 per million, ranked in all cancer death and is higher than that of our neighboring countries. Moreover, oral cancer is also the 2nd most prevalent cancer in male Taiwanese between the age of 25~44. As males within this age group usually play very important role in the familial structure and are responsible for economic support, oral cancer might have caused a socioeconomic problem for the family. Most of the oral cancer are in advanced stage when presented to their physician. Multidisciplinary team work is needed for a good therapeutic outcome. However, current surgery and radiotherapy usually will result in cosmetic disfiguration, impairment of chewing, dysphagia, and speech problem. As such, patients' socioeconomic status might have changed dramatically after therapy. Recent advances in the management of HNSCC will be presented here. These include: (1) relationship of human papilloma virus with HNSCC, (2) advancement of image modality, e.g. positron emission tomography (PET) and MRI, (3) prognostic factors identification and multidisciplinary team work, (4) advance of radiotherapy, (5) expanded role of chemotherapy, and (6) incorporation of molecular targeted therapy. These effort will help us to provide the personalized cancer therapy at right time for best candidate to ensure the best therapeutic outcome and least adverse event.

並列關鍵字

head and neck neoplasm ； oral cavity cancer ； betel quid ； human papilloma virus ； positron emission tomography PET ； molecular targeted therapy