头颈部鳞癌发病机制与治疗研究进展

Basic research and clinical advances in squamous cell carcinoma of the head and neck

头颈部鳞状细胞癌约占全身恶性肿瘤的6%,全球每年新发病例超过50万例。对其发病机制,近年来有一些新的发现,人乳头瘤病毒是除烟酒因素外另一个重要的头颈癌致病因素,表皮生长因子受体(EGFR)的信号传导与鳞癌的发生和转移亦有密切联系。Ⅰ、Ⅱ期头颈癌患者,通过单纯手术或放疗,均可取得较好效果。以多西他赛、顺铂、氟尿嘧啶为主的化疗药物,与调强放疗及不同分割方式联合的同期化放疗方案,是Ⅲ、Ⅳ期晚期口咽癌、下咽癌及喉癌的重要治疗手段。作用于EGFR靶点的西妥昔单抗,无论是单药或与放疗联合,均显示了很好的应用前景,在临床上逐步被广泛接受,提示靶向联合治疗可作为肿瘤手术后新的辅助治疗方法。Ⅲ、Ⅳ期局部晚期头颈癌患者的多中心临床试验尚在进行中,其联合治疗方案有待统一。

Squamous cell carcinoma of the head and neck（SCCHN） has been estimated to account for approximately 6% -7% of all malignancies, with more than 500 thousands newly diagnosed cases of SCCHN worldwide each year. Tobacco, alcohol and HPV are the most important causative factors in the development of oropharyngeal cancer. Cetuximab, an anti-EGFR monoelonal antibody, is able to inhibit phosphorylation of EGFR and to prevent signal transduction of EGFR so as to be a prominent target agent and treatment approach for SCCHN. Docetaxel, cisplatin, and fluorouraeil are primarily administered concurrently with intensity modulated radiation therapy with the accelerated or hyperfractionated treatment for stage Ⅲ or Ⅳ, locally advanced oropharyngeal, hypopharyngeal and laryngeal cancer. Although phase 3 trials involving patients with advanced SCCHN are ongoing, cetuximab has been promising both as single agent and in combination with radiotherapy as a postoperative adjuvant treatment for SCCHN.