头颈部鳞癌患者同步放化疗和（或）分子靶向治疗继发口腔黏膜炎的防治

Management of oral mucositis in patients with head and neck cancer receiving chemoradiotherapy and/or molecular targeted therapy

目的探讨接受同步放化疗和（或）分子靶向药物治疗的中晚期头颈部鳞癌患者口腔黏膜炎的防治。方法回顾性分析2007年11月至2010年11月期间接受同步放化疗和（或）分子靶向药物治疗的179例中晚期头颈部鳞癌患者口腔黏膜炎发生情况及治疗效果。男155例，女24例。临床分期：Ⅲ期124例，Ⅳ期55例。口腔黏膜炎发生情况：Ⅰ级49例，Ⅱ级50例，Ⅲ级67例，Ⅳ级13例。接受同步放化疗的同时采取预防口腔黏膜炎的方法，对发生黏膜炎的患者采用常规治疗结合喹诺酮类抗生素的方法进行治疗。结果99例Ⅰ、Ⅱ级和4例Ⅲ级口腔黏膜炎患者经常规治疗达到有效控制，即口腔黏膜炎性反应范围减少，疼痛明显减轻，可进食。76例Ⅲ、Ⅳ级口腔黏膜炎患者通过常规治疗结合喹诺酮类抗生素，得到有效控制。无一例患者出现放疗中断及抗生素药物相关的毒副作用。结论对接受同步放化疗和（或）分子靶向药物治疗的中晚期头颈部鳞癌患者发生的口腔黏膜炎，轻度患者采用常规治疗有效，中重度患者采用抗生素治疗有效。

Objective To investigate the prevalence and treatment of oral mucositis caused by concurrent chemoradiotherapy and/or molecular targeted therapy in the patients with advanced squamous cell carcinoma of the head and neck. Methods A retrospective study of the incidence and treatment of oral mncositis was performed in 179 patients （155 male and 24 female;124 patients at stage Ⅲ and 55 patients at stage Ⅳ） receiving concurrent chemotherapy and （or） molecular targeted therapy between November 2007 and November 2010. Grade Ⅰ , Ⅱ , Ⅲ and Ⅳ oral mucositis occurred respectively in 49, 50, 67 and 13 patients. All the patients received oral mucositis prophylaxis. After the occurrence of oral mucositis, conventional treatment of mucositis combined with quinolone antibiotics were applied. Results Of the patients, 99 patients with grade Ⅰ or U and 4 patients with grade Ⅲ oral mucositis were effectively managed by conventional treatment; 76 patients with grade m or IV oral mncositis were also significantly controled by conventional treatment plus antibiotics. After the treatments, all patients with oral mucositis were under control, with the decrease in the grade of oral mucositis, the reduction of oral pain and the improvement in ability to eat. None of them had radiation treatment breaks. Conclusions Combined modality therapy can effectively control chemoradiation-induced oral mucositis in patients with head and neck squamous cell carcinoma, grade Ⅰ and Ⅱ oral mucositis were cured by conventional treatment and quinolone antibiotics play a key role in the treatmeats for grade Ⅲ and and Ⅳ oral mucositis.