頭頸部腫瘤課件

1、頭頸部腫瘤頭頸部腫瘤概述口腔腫瘤新輔助化療2019 ASCO流行病學(xué)占全身惡性腫瘤的5第6大常見(jiàn)的惡性腫瘤腫瘤相關(guān)死亡原因的第8位頭頸部腫瘤的患者有可能罹患第2個(gè)原發(fā)性的頭頸部、肺部或食管的腫瘤病因吸煙和嗜酒口咽癌：人乳頭瘤病毒(HPV) 60-70%鼻咽癌：EBVHPV+口咽部腫瘤的療效和生存情況均比HPV- 的腫瘤要好治療前血漿EBV-DNA水平越高，則治療后出現(xiàn)遠(yuǎn)處轉(zhuǎn)移的概率越高；監(jiān)測(cè)隨訪Humanpapillomavirusandsurvivalofpatientswithoropharyngeal cancer. N Engl J Med.2019 Jul 1;363(1):24-3

2、5.頭頸部腫瘤特點(diǎn)90%以上EGFR過(guò)表達(dá)以鱗癌為主視、聽、嗅覺(jué)、呼吸、發(fā)聲、進(jìn)食、容貌局部結(jié)構(gòu)復(fù)雜、險(xiǎn)隘，安全邊緣有限“不可切除的病變” 沒(méi)有定義不同部位特點(diǎn)不同喉癌：聲門上區(qū)腫瘤在確診時(shí)通常已經(jīng)為局部晚期；但是聲門區(qū)腫瘤發(fā)現(xiàn)時(shí)多為早期，治愈率非常高：約80%90%咽癌：大約60%的下咽部腫瘤患者已屬局部晚期伴區(qū)域淋巴結(jié)轉(zhuǎn)移，預(yù)后通常都很差分期唇部、口腔及口咽部腫瘤根據(jù)瘤體大小界定T分期聲門區(qū)、聲門上區(qū)、喉咽及鼻咽部腫瘤根據(jù)各自亞區(qū)侵犯情況界定T分期除了鼻咽癌的區(qū)域淋巴結(jié)（N）分期之外，對(duì)于不同部位腫瘤的N及遠(yuǎn)處轉(zhuǎn)移（M）的界定標(biāo)準(zhǔn)是一致的喉、口咽、下咽：VII區(qū)（上縱膈）轉(zhuǎn)移也被認(rèn)為是區(qū)域

3、淋巴結(jié)轉(zhuǎn)移治療特點(diǎn)T1-2N0M0期: 單純手術(shù)或單純放療局部晚期: 手術(shù)+放療+化療復(fù)發(fā)和轉(zhuǎn)移，姑息性化療放療+化療+手術(shù)鼻咽癌主要以放化療為主新輔助治療例如：對(duì)可手術(shù)切除的局部晚期喉癌、咽癌，術(shù)前誘導(dǎo)化療/同步放化療不僅可以提高保喉率，而且可提高患者生存率放療原發(fā)病灶和受侵淋巴結(jié)需要每天2.0 Gy，總量為70 Gy或以上的劑量對(duì)于頸部風(fēng)險(xiǎn)較低的淋巴結(jié)群的放療劑量為每天2.0 Gy，總量50 Gy或以上化療新輔助化療同步放化療（根治性、輔助性）輔助化療姑息化療靶向治療西妥昔單抗 早中期：同步放療 晚 期：?jiǎn)嗡幓蚵?lián)合化療尼妥珠單抗（nimotuzumab）吉非替尼、厄洛替尼：未觀察到臨床受益

4、不良預(yù)后因素淋巴結(jié)包膜外受侵和/或手術(shù)切緣陽(yáng)性：術(shù)后進(jìn)行輔助性化放療其他不良預(yù)后因素：多個(gè)陽(yáng)性淋巴結(jié)（無(wú)包膜外受侵）、血管/淋巴管/神經(jīng)周圍侵犯、原發(fā)腫瘤T4a及具有IV區(qū)淋巴結(jié)陽(yáng)性術(shù)后放療，但是否進(jìn)行放化療可根據(jù)臨床判斷復(fù)發(fā)和(或)轉(zhuǎn)移復(fù)發(fā)病變可治愈：應(yīng)積極尋求根治性手術(shù) 或同步放化 （靶）療無(wú)局部治愈可能：姑息性化療和(或)靶向治療 支持治療姑息化療的中位生存時(shí)間大約為6個(gè)月，1年生存率大約為20%Induction ChemotherapyInduction chemotherapy plus radiation compared with surgery plus radiation

5、in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study GroupN Engl J Med.1991;324(24):1685332 ptsmedian follow-up of 33 monthssurgery +radiotherapyinduction chemotherapy+ radiotherapySalvage surgerycisplatin +fluorouraci（PF）Focus on larynx preservation

6、2-year survival: 68% : 68%P=0.1195Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial.EORTCHead and Neck Cancer Cooperative Group J Natl Cancer Inst.2019202 ptssurgery +radiotherapyinduction chemotherapy+ r

7、adiotherapySalvage surgerycisplatin +fluorouraci（PF）Focus on larynx preservation Induction-chemotherapy arm vs. Surgery armOS: 44 : 25 months3-year survival: 57% : 43%PFS: 25 : 20 monthsTPF vs. PFInduction chemotherapy with cisplatin and fluorouracil alone or in combination with docetaxel in locally

8、 advanced squamous-cell cancer of the head and neck: long-term results of the TAX 324 randomised phase 3 trial. Lancet Oncol.2019;12(2):153-9Median follow-up of 6.0 years (72.2 months)55 centers 501 /pmc/articles/PMC4356902/pdf/nihms667891.pdfOS: 70.6 vs. 34.8 moPFS: 38.1 vs.

9、 13.2 mohypopharyngeal and laryngealPFS: 20.9 vs. 10.1 moOS: 51.9 vs. 23.5 moLong-term results of GORTEC 2000-01: A multicentric randomized phase III trial of induction chemotherapy with cisplatin plus 5-fluorouracil, with or without docetaxel, for larynx preservation. France213 ptsMedian follow-up

10、105 months TPF vs. PFThe 5- and 10-year larynx preservation rates 74.0% vs. 58.1% 70.3% vs. 46.5%The 5- and 10-year LDFFS rates 67.2% vs. 46.5% 63.7% vs. 37.2% OS, PFS no difference (LDFFS :larynx dysfunction-free survival) ASCO2019Taxane-cisplatin-fluorouracil as induction chemotherapy for advanced

11、 head and neck cancer: a meta-analysis of the 5-year efficacy and safety. Springerplus.2019;4:208.7 randomized clinical (mata analysis) TPF vs. PF 3-year OS rate (HR: 1.14; 95% CI: 1.03 to 1.25; P=0.008) 3-year PFS rate (HR: 1.24; 95% CI: 1.08 to 1.43; P=0.002) 5-year OS rate (HR: 1.30; 95% CI, 1.09

12、 to 1.55;P=0.003) 5-year PFS rate (HR: 1.39; 95% CI, 1.14 to 1.70; P=0.001)The TPF induction chemotherapy improved PFS and OS compared with PFInduction Chemotherapy vs. Concurrent ChemoRTLong-Term Results of RTOG 91-11: A Comparison of ThreeNonsurgical Treatment Strategies to Preserve the Larynx inP

13、atients With Locally Advanced Larynx Cancer J Clin Oncol 2019;31:845-852Patients with stage III or IV glottic or supraglottic squamous cell cancerlaryngectomy-free survival (LFS)(PF)For selected patients with hypopharyngeal and laryngeal cancers less than T4a in extent, inductionchemotherapyused as

14、part of a larynx preservation strategyis category 2AThus, induction chemotherapy has a category 3recommendation for the management of both locally and regionally advanced oropharyngeal cancerInduction Chemotherapy in Oral Squamous Cell CarcinomaRandomized Phase III Trial of Induction Chemotherapy Wi

15、th Docetaxel, Cisplatin, and Fluorouracil Followed by Surgery Versus Up-Front Surgery in Locally Advanced Resectable Oral Squamous Cell Carcinoma J Clin Oncol.2019 ;31(6):744-51256 patientsLocallyadvancedResectable Oral Squamous Cell Carcinoma, TPFMedian follow-up of 30 monthscN2Induction chemothera

16、py + Concurrent chemoradiotherapyInduction chemotherapy followed by concurrentchemoradiotherapy (sequential chemoradiotherapy) versusconcurrent chemoradiotherapy alone in locally advanced headand neck cancer (PARADIGM): a randomised phase 3 trialLancet Oncol 2019; 14: 25764145 patients across 16 sit

17、esMedian follow-up of 49 months Induction chemotherapy + Concurrent chemoradiotherapy Concurrent chemoradiotherapy3-year overall survival was 73% vs. 78%OSPFSPhase III randomized trial ofinduction chemotherapyin patients with N2 or N3 locally advancedhead and neck cancer. J Clin Oncol.2019; 32(25):2

18、735285 patients , with N2 or N3 diseaseFollow-up of 30 monthsInduction chemotherapy + Concurrent chemoradiotherapy Concurrent chemoradiotherapyNO difference: OS, Relapse-FreeSurvival , Distant Failure-Free SurvivalIs there a role for induction chemotherapy in the setting of concomitant chemoradiatio

19、n in locally advanced head and neck cancer: A systematic review and meta-analysis of randomized controlled trialsMeta-analysis, 5 RCTs ( 4 TPF, 1 PF )1229 patientsIndu-chemotherapy + concomitant chemoradiation concomitant chemoradiationOS, PFS no difference have a trendDisease control , CR Imply tha

20、t selected patients may benefit from the addition of induction chemotherapyASCO2019New aspects regarding the induction chemotherapy with TPF and radio chemotherapy in head and neck cancer GermanyMeta-analysis, 5 RCTs (TPF)1060 patients, locally advanced53.4% oropharyngeal, 17.3% hyopharyngeal, 6.4%

21、laryngeal, 18.5% oral cavity , 4.4% other SCCHNTPF + concomitant chemoradiation concomitant chemoradiationNot result in a significant improvement of OS (Hazard Ratio: 0.950, 0.791-1.140, p = 0.579)ASCO2019Radiotherapy plus cetuximabRadiotherapy plus cetuximab for locoregionally advanced head and nec

22、k cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival Lancet Oncol.2019 ;11(1):21-8424 pts: locoregionally advanced squamous-cell carcinoma (oropharynx, hypopharynx, or larynx)73 centresmedian follow-up 60 monthsradiotherapy alonerad

23、iotherapy plus cetuximabOS: 49.0 months versus 29.3 months5-year overall survival was 45.6% versus 36.4%Randomized phase III trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III to IV head and neck carcinoma: RTOG 0522. J Clin Oncol.2019 Sep 20;32(27):2940

24、-50.891 analyzed patientsMedian follow-up 3.8 yearsCetuximab plus cisplatin-radiationcisplatin-radiation alone3-year PFS (61.2% v. 58.9%, P = .76), 3-year OS (72.9% v. 75.8, P = .32)p16-positive compared with p16-negative PFS (72.8% v. 49.2%, P .001) OS (85.6% v. 60.1%, P .001),EGFR expression did n

25、ot distinguish outcomeShould not be prescribed routinelyOral CavityVery advanced2019 ASCOHead and Neck CancerPhase III randomized trial of standard fractionation radiotherapy with concurrent cisplatin versus accelerated fractionation radiotherapy with panitumumab in patients with locoregionally adva

26、nced squamous cell carcinoma of the head and neck: NCIC Clinical Trials Group HN.6 trialCanada320 pts With a median follow-up of 46.4 monthsPFS of PMab +AFX was not superior to CIS +SFXWeekly paclitaxel, carboplatin, cetuximab (PCC), and cetuximab, docetaxel, cisplatin, and fluorouracil (C-TPF), fol

27、lowed by risk-based local therapy in previously untreated, locally advanced head and neck squamous cell carcinoma (LAHNSCC) MD Anderson Cancer Centerphase IIMedian follow-up of 18.4 months 136 patients Mutational patterns of HPV + and HPV- squamous cell carcinomas of the head and neck (SCCHN) and th

28、eir interference with outcome after adjuvant chemoradiation: A multicenter biomarker study of the German Cancer Consortium Radiation Oncology Group Germany208 patients211 exons from 45 genes HPV +： enriched for activating mutations in driver genes (PIK3CA 27% , KRAS 8%, NRAS 4%, HRAS 2%) HPV- ：loss-

29、of-function alterations in tumor suppressor genes (TP5367%, CDKN2A 30%, PTEN 4%, SMAD4 3%) median follow-up of 55 months, loss-of-function tumor suppressor gene mutations negatively interfere with efficacy of adjuvant cisplatin-based chemoradiation, whereas activating driver gene mutations define po

30、or risk specifically in HPV-driven SCCHNAntitumor activity and safety of pembrolizumab (MK-3475) in patients with advanced squamous cell carcinoma of the head and neck: Preliminary results from KEYNOTE-012 expansion cohort ChicagoORR(Objective Response Rate) was 18.2%31.3% with stable diseaseBiomark

31、er analysis is ongoingFinal overall survival analysis of EXAM, an international, double-blind, randomized, placebo-controlled phase III trial of cabozantinib (Cabo) in medullary thyroid carcinoma (MTC) patients with documented RECIST progression at baseline. France是RET，VEGFR2和MET酪氨酸激酶的強(qiáng)效抑制劑，于2019年11

32、月被美國(guó)FDA批準(zhǔn)用于MTC的治療median follow up time 52.4 moN= 330median OS 26.6 mo vs 21.1 mo ( p = 0.241). median OS 44.3 mo vs 18.9 mo (p = 0.026) , For 126 pts with RET M918T mutations Efficacy and safety of lenvatinib for the treatment of patients with 131I-refractory differentiated thyroid cancer with and w

33、ithout prior VEGFtargeted therapy. London PFS 18.3 vs. 3.6 mo2019.4 FDAUtilization and outcomes of low dose versus high dose cisplatin in head and neck cancer patients receiving concurrent radiation. Milwaukee1,091 ptsLD ( 40 mg/m2) ， HD ( 75 mg/m2) The total cumulative dose 322.5 mg vs. 475.8 mgOS

34、favoring the HD group(log rank test, p 0.001) 75% censored in both cohortsDifferential impact of cisplatin dose intensity on human papillomavirus (HPV)-related ( + ) and HPV-unrelated ( - ) locoregionally advanced head and neck squamous cell carcinoma (LAHNSCC). Canada （retrospective）Median follow-u

35、p was 4.3 yrs5 year OS was inferior for HPV（ - ）CDDP 200 vs. 200 mg/m2 (44 % vs 62%, p 0.01)But not to HPV（ +）A meta-analysis of weekly cisplatin versus three weekly cisplatin chemotherapy plus current radiotherapy for advanced head and neck cancer. Yue Zhang Southern Medical University, Guangzhou,

36、China779 patients of 10 studies Three weekly cisplatin CRT didnt differ with weekly in OS and LRFS(locoregional recurrence-free survival)A meta-analysis comparing cisplatin-based to carboplatin-based chemotherapy in moderate to advanced squamous cell carcinoma of head andneck (SCCHN). Qinyang Li, Na

37、nfang Hospital, Southern Medical University, Guangzhou, ChinaPatients with CDDP-based CT can achieve a higher OS, but there is no significant difference in LRCBioradiotherapy for head and neck cutaneous squamous cell carcinoma , Philadelphia68 patients Median follow-up 30 monthsPhase II study with c

38、onventional radiotherapy + cetuximab in patients with advanced larynx cancer who responded to induction chemotherapy : An organ preservation TTCC study. Spain93 patients , one armMedian follow-up: 48 monthsLEDFS(the laryngo-esophageal dysfunctionfree survival ) rate was clearly higher than the criti

39、cal value and with an acceptable toxicity with this protocol, so it is warranted to move to a phase III trialThe role of cetuximab in induction chemotherapy: Comparison of APF-C( nab-paclitaxel, cisplatin, 5-FU+ cetuximab) with APF, both followed by chemoradiation therapy (CRT), in patients with loc

40、ally advanced head andneck squamous cell carcinoma (HNSCC). St. LouisBackground: Cetuximab improved OS in patients with HNSCC when added to definitive RT or to palliative chemotherapy60 pts Two year OS and DSS(disease-specific survival) were similar between APF+C and APF, even when stratified for p1

41、6 status.Concurrent chemoradiation using weekly versus tri-weekly cisplatin in locally advanced squamous cell carcinoma of the head and neck (SCCHN): A comparative analysis. AtlantaOut of 120 studies, 23 with a total of 2,303 patients Weekly cisplatin combined with radiation in locally advanced SCCH

42、N is comparable in efficacy and safety to tri-weekly based regimens. 總結(jié)個(gè)體化治療，綜合和治療對(duì)部分選擇的患者，誘導(dǎo)化療是可行的，在局部疾病控制、器官保留方面可以帶來(lái)益處，能降低遠(yuǎn)處轉(zhuǎn)移發(fā)生率，并有可能轉(zhuǎn)化為生存獲益誘導(dǎo)化療仍缺乏有效的篩選標(biāo)記靶向治療，特別是免疫治療未來(lái)會(huì)帶來(lái)突破THANKS同步放化療隨機(jī)臨床試驗(yàn)支持幾種順鉑的使用方案（例如每周，每天，但大多數(shù)醫(yī)療中心采用高劑量順鉑治療（每3周100 mg/m2）口腔癌口腔癌口腔癌鼻咽癌在頭頸部腫瘤中，它具有最高的遠(yuǎn)處轉(zhuǎn)移傾向。局部晚期鼻咽癌在根治性放療（未行化療）后很容易

43、出現(xiàn)孤性局部復(fù)發(fā)。區(qū)域復(fù)發(fā)不常見(jiàn)，僅占患者的10%19%治療前血清/血漿中EBV-DNA水平與早期鼻咽癌(I期和II期)的預(yù)后有關(guān)，治療前血漿EBV-DNA水平越高，則治療后出現(xiàn)遠(yuǎn)地轉(zhuǎn)移的概率越高聯(lián)合使用放療和鉑類藥物化療已被證實(shí)腫瘤的局部控制率可以從54%增加到78%鼻咽部腫瘤患者治療后，推薦的隨訪內(nèi)容包括定期體檢和甲狀腺功能的評(píng)估（每612個(gè)月檢測(cè)TSH水平）在20%25%的接受頸部放療的患者當(dāng)中可檢測(cè)出TSH水平增高鼻咽癌初始治療決策手術(shù)放療同步放化療新輔助化療唇、口腔、咽、喉、鼻竇、涎腺等pembrolizumab是西妥昔單抗療效(1013%)的約兩倍EGFR-抑制劑在HPV-陽(yáng)性腫瘤

44、中療效不佳pembrolizumab在HPV-陽(yáng)性和HPV-陰性腫瘤中均有相似活性水平緩解率可能低估患者的獲益比例病情穩(wěn)定或即使最初經(jīng)歷疾病進(jìn)展的患者一旦接受免疫治療最終可能變?yōu)殚L(zhǎng)期生存期的獲益Nonetheless, interest in the role of induction chemotherapy was renewed several years ago for a few reasonsAdvances in surgery, RT, and concurrent systemic therapy/RT have yielded improvements in local/r

45、egional control thus, the role of distant metastases as a source of treatment failure has increased and induction chemotherapy allows greater drug delivery for this purposeMost randomized trials of inductionchemotherapy followed by RT and/or surgery compared to locoregional treatment alone, which we

46、re published in the 1980s and 1990s, did not show an improvement in overall survival with the incorporationof chemotherapy.273in selected patients, induction chemotherapy couldfacilitate organ preservation, avoid morbid surgery, and improve overall quality of life of the patient even though overall

47、survival was not improved. Because total laryngectomy is among the procedures mostfeared by patients,281 larynx preservation was the focus of initial studies誘導(dǎo)化療治療頭頸鱗癌的爭(zhēng)議 上海交通大學(xué)醫(yī)學(xué)院附屬第九人民醫(yī)院 鄭家偉發(fā)布時(shí)間：2019-5-2 11:24:40頭頸部由于特殊的解剖部位和復(fù)雜的功能，給惡性腫瘤的治療提出了挑戰(zhàn)。早期頭頸癌，無(wú)論采用手術(shù)或放療，均能獲得良好的效果，無(wú)需多手段治療；但遺憾的是，60%的頭頸癌就診時(shí)已屬晚

48、期（III、IV期），5年生存率徘徊在10%20%之間。對(duì)大多數(shù)局部晚期、腫瘤無(wú)法切除及需器官保存的腫瘤患者，目前公認(rèn)的標(biāo)準(zhǔn)治療是同期化放療。對(duì)腫瘤復(fù)發(fā)或遠(yuǎn)處轉(zhuǎn)移的患者，如果腫瘤對(duì)鉑類或紫杉醇類藥物治療不敏感，則只能給予患者支持治療。誘導(dǎo)化療（induction chemotherapy）是指手術(shù)或放療前進(jìn)行的化療，又稱為新輔助化療（neoadjuvant chemotherapy），作為腫瘤化學(xué)治療的一種方式，用于頭頸鱗癌已有近30年的歷史，但其在腫瘤治療中的確切作用一直頗受爭(zhēng)議。爭(zhēng)論的焦點(diǎn)是在提高局部控制率和生存率方面的確切作用，爭(zhēng)議產(chǎn)生的主要原因，是其理論上明顯的優(yōu)勢(shì)與以往臨床試驗(yàn)顯示誘

49、導(dǎo)化療對(duì)患者生存率沒(méi)有明顯改善之間的矛盾。文獻(xiàn)報(bào)道的各種誘導(dǎo)化療方案的隨機(jī)對(duì)照試驗(yàn)（RCT）結(jié)果不一，有些稱顯著有效，有些則認(rèn)為無(wú)效，但多數(shù)研究認(rèn)為，PF誘導(dǎo)化療雖然暫時(shí)有效甚至顯效，但不能顯著提高這類患者的遠(yuǎn)期生存率。屠規(guī)益教授認(rèn)為：從臨床醫(yī)師的角度而言，我們要求的是確實(shí)（有“根治性”）有效的實(shí)用方案，可以在臨床上重復(fù)應(yīng)用。迄今為止，化療在惡性腫瘤尤其是造血系統(tǒng)腫瘤的治療中已經(jīng)發(fā)揮了很大作用。但是，無(wú)論是新藥還是常規(guī)藥物、無(wú)論是單藥還是多種藥物聯(lián)合應(yīng)用、無(wú)論是單獨(dú)化療或綜合（放療、手術(shù)）應(yīng)用，對(duì)頭頸鱗癌尚沒(méi)有確切的“根治性療效”，尚沒(méi)有確實(shí)可以加強(qiáng)其他治療手段的結(jié)果報(bào)告。建議目前臨床上不宜對(duì)

50、頭頸鱗癌患者常規(guī)應(yīng)用化療作為根治性治療或輔助措施。China J Oral Maxillofac Surg,2019,4(3):162-165.Marshall R. Posner 教授（Dana Farber癌癥研究所，波士頓馬薩諸塞，美國(guó)）認(rèn)為：聯(lián)合應(yīng)用順鉑與5氟尿嘧啶一直被視為標(biāo)準(zhǔn)新輔助治療，術(shù)前化療能夠降低腫瘤的遠(yuǎn)處轉(zhuǎn)移率，但其在提高患者生存率方面并沒(méi)有足夠證據(jù)。China J Oral Maxillofac Surg,2019,4(5):322-329.目前的結(jié)論誘導(dǎo)化療對(duì)提高腫瘤局部控制率的作用：最初將誘導(dǎo)化療應(yīng)用于頭頸晚期鱗癌的治療，目的是為了提高局部控制率，達(dá)到提高生存率的目的

51、。但臨床研究中并沒(méi)有足夠的證據(jù)表明，誘導(dǎo)化療能夠有效提高手術(shù)對(duì)頭頸部鱗癌的控制率。這是因?yàn)榫植靠刂坡实奶岣?，一方面依賴于誘導(dǎo)化療的療效，量效不夠的誘導(dǎo)化療、腫瘤對(duì)化學(xué)藥物的低反應(yīng)率反而影響了局部治療的效果；另一方面，頭頸晚期鱗癌是異質(zhì)性非常大的一族疾病群，手術(shù)治療的效果在很大程度上決定于患者的發(fā)病部位、病變范圍以及周圍的解剖關(guān)系。誘導(dǎo)化療對(duì)遠(yuǎn)處轉(zhuǎn)移的抑制作用：有效地減少遠(yuǎn)處轉(zhuǎn)移率，是誘導(dǎo)化療對(duì)腫瘤治療的一大優(yōu)勢(shì)。Paccagnella等通過(guò)以順鉑和5-氟尿嘧啶為基礎(chǔ)的誘導(dǎo)化療治療晚期頭頸鱗癌，將3年遠(yuǎn)處轉(zhuǎn)移率由38%降到14%（P=0.002）。退伍軍人事務(wù)部喉癌研究組（Veterans Affairs Laryngeal Cancer Study Group）開展的通過(guò)誘導(dǎo)化療達(dá)到器官保留目的的III期隨機(jī)試驗(yàn)也發(fā)現(xiàn)，PF方案（順鉑，第1天100mg/m2;第15天，5-氟尿嘧啶1000mg/m2持續(xù)輸注）的誘導(dǎo)化療組較少地發(fā)生遠(yuǎn)處轉(zhuǎn)移。術(shù)前誘導(dǎo)化療在頭頸腫瘤治療中的角色轉(zhuǎn)變進(jìn)展1新藥開發(fā)和聯(lián)合用藥方案：誘導(dǎo)化療的研究進(jìn)展