Clinicopathological study of malignant peripheral nerve sheath tumors in the head and neck:Case reports and review of literature

BACKGROUND Malignant peripheral nerve sheath tumor(MPNST)is a rare and aggressive soft tissue sarcoma that poses a major diagnostic and therapeutic challenge.CASE SUMMARY We retrospectively reviewed patients with head and neck MPNSTs treated in our hospital from 2000 to 2021.The clinical features,pathological manifestations,treatments,and prognoses were summarized.We also reviewed the literature,focusing on MPNST in the mandible and maxilla.The study population consisted of five women and five men aged 22–75 years(mean age,49 years).Of the 10 patients,7 were initial cases and 3 were recurrent cases.All lesions were sporadic.The most common site was the mandible.The most frequently encountered symptoms were a progressive mass and local swelling.Complete or partial loss of trimethylation at lysine 27 of histone H3(H3K27me3)was evident on staining in four of nine cases(one case was excluded due to lack of tissue for evaluation of loss of H3K27me3).The 2-and 5-year disease-specific survival rates were 86%a nd 43%,respectively.The average survival time was 64 mo.CONCLUSION MPNST is a highly malignant tumor with a poor prognosis,prone to a high risk of recurrence and distant metastasis.Complete surgical resection is the main treatment.

Positron-emission tomography/computed tomography imaging in head and neck oncology:An update

Cancers of the head and neck account for more than half a million cases worldwide annually, with a significant majority diagnosed as squamous cell carcinoma(HNSCC). Imaging studies such as contrast-enhanced computed tomography(CT), magnetic resonance imaging(MRI) and ^(18)F-2-fluoro-2-deoxy-D-glucose positron-emission tomography/computed tomography(^(18)F-FDG PET/CT) are widely used to determine the presence and extent of tumors and metastatic disease, both before and after treatment. Advances in PET/CT imaging have allowed it to emerge as a superior imaging modality compared to both CT and MRI, especially in detection of carcinoma of unknown primary, cervical lymph node metastasis, distant metastasis, residual/recurrent cancer and second primary tumors, often leading to alteration in management. PET/CT biomarker may further provide an overall assessment of tumor aggressiveness with prognostic implications. As new developments emerged leading to better understanding and use of PET/CT in head and neck oncology, the aim of this article is to review the roles of PET/CT in both pre- and post-treatment management of HNSCC and PET-derived parameters as prognostic indicators.

Malignant proliferative ependymoma of the neck with lymph node metastasis:A case report

BACKGROUND Malignant proliferating trichilemmal tumor(MPTT)is an infrequent malignant neoplasm originating from cutaneous appendages,with only a handful of documented cases.This report delineates a unique instance of MPTT situated in the neck,accompanied by lymph node metastasis.A comprehensive exposition of its clinical trajectory and imaging manifestation is presented,aiming to enhance comprehension and management of this atypical ailment.CASE SUMMARY Patient concerns:A 79-year-old male presented with a longstanding right neck mass persisting for over six decades,exhibiting recent enlargement over the past year.Diagnoses:Enhanced magnetic resonance imaging of the neck unveiled an elliptical mass on the right neck side,characterized by an ill-defined border and a heterogeneous signal pattern.The mass exhibited subdued signal intensity on T1-weighted imaging(T1WI)and a heterogeneous high signal on T2-weighted imaging(T2WI),interspersed with a lengthy T1 and T2 cystic signal motif.Close anatomical association with the submandibular gland joint was noted,and intravenous gadolinium diethylene triamine pentaacetic acid administration facilitated conspicuous enhancement.Substantial enhancement of the solid segment prompted an initial preoperative diagnosis of malignant nerve sheath tumor.However,post-surgery histopathological and immunohistochemical analysis conclusively confirmed the diagnosis as malignant hyperplastic external hair root sheath tumor.Intervention:Complete excision of the tumor was successfully executed.Outcomes:The patient experienced a favorable postoperative recovery.CONCLUSION Malignant proliferative trichilemmal tumor external hair root sheath tumor is a cystic-solid lesion,appearing as low signal on T1WI images or high signal on T2WI with enhancement of the solid component.Suspicions of malignancy are heightened when the tumor border is indistinct,tissue planes are breached,or when linear or patchy high signals are observed in the subcutaneous tissue on T1 liver acquisition with volume acceleration enhanced images along with intermediate signal on T2WI and restricted diffusion on diffusion-weighted imaging images.Strong consideration for malignancy should arise if there are signs of compromised adjacent tissue relationships or direct invasion evident on imaging.We have incorporated the above-mentioned content into the entire manuscript.

Pilomatrix Carcinoma of the Head and Neck: Case Report and Review of the Literature

Pilomatrix Carcinoma (PC) is an exceedingly rare neoplasm. Although it has been described at various anatomical sites, fewer than 25 cases have been reported in the face and scalp. Although early recognition and treatment is paramount in optimization of outcomes for this aggressive carcinoma, the diagnosis is complicated by shared features with its more common benign counterpart. In patients with recurrence or rapid growth of a pilomatrixoma, pilomatrix carcinoma should be considered in the differential diagnosis.

Squamous cell carcinoma of the oral cavity and circulating tumour cells

Due to a lack of substantial improvement in the outcome of patients suffering from oral squamous cell carcinoma(OSCC) during the past decades, current staging methods need to be revised. This disease is associated with poor survival rates despite considerable advances in diagnosis and treatment. The early detection of metastases is an important indicator of survival, prognosis and relapse. Therefore, a better understanding of the mechanisms underlying metastasis is crucial. Exploring alternative measures apart from common procedures is needed to identify new prognostic markers. Similar to previous findings predominantly for other solid tumours, recently published studies demonstrate that circulating tumour cells(CTCs) and disseminated tumour cells(DTCs) might serve as prognostic markers and could supplement routine staging in OSCC. Thus, the detection of CTCs/DTCs is a promising tool todetermine the individual need for therapeutic intervention. Encouraging results and new approaches point to the future use of targeted therapies for OSCC, an exceedingly heterogeneous subgroup of head and neck cancer. This review focuses on summarising technologies currently used to detect CTCs/DTCs. The translational relevance for OSCC is highlighted. The inherent challenges in detecting CTCs/DTCs will be emphasised.

Synchronous occurrence of extramedullary plasmacytoma and squamous cell carcinoma in situ in the larynx: a case report

Extramedullary plasmacytoma of the larynx is rare, especially when coexisted with squamous cell carcinoma in situ. We report a 56-year-old woman with hoarseness for 6 months and dysphonia for a week. Fiberoptic laryngoscopic examination showed a red, smooth-surface swelling in the submucous region of the left ventricle and ventricular band of the larynx. The patient underwent vertical laryngectomy and modified left neck dissection. Postoperative pathologic examination revealed coexisting plasmacytoma and carcinoma in situ. Bone marrow biopsy and systemic radiogram showed no positive findings. The hepatic and renal functions were normal. Monoclonal immunoglobulin light chain of type kappa was detected in urine. Hence, a laryngeal extramedullary plasmacytoma with carcinoma in situ was diagnosed. No recurrence or progression was observed during a 2-year follow-up. Here, we discussed the risk factors, diagnosis, and therapy for this rare disease.

尼妥珠单抗联合放化疗治疗局部晚期头颈部恶性肿瘤的临床效果

目的分析局部晚期头颈部恶性肿瘤实施尼妥珠单抗+放化疗治疗的价值。方法选取滕州市中心人民医院于2021年11月—2022年11月收治的72例局部晚期头颈部恶性肿瘤患者为研究对象,依掷骰子分为基础组和综合组,每组36例,基础组行放化疗,综合组加用尼妥珠单抗,对比两组的近远期疗效和不良反应。结果综合组的临床缓解率(58.33%),和临床控制率(88.89%)均高于基础组(30.56%、66.67%),差异有统计学意义(χ^(2)=5.625、5.143,P=0.018、0.023)。随访1年后综合组生存率(80.56%)高于基础组(58.33%),差异有统计学意义(P<0.05)。两组各项不良反应反应率比较,差异无统计学意义(P>0.05)。结论放化疗时辅以尼妥珠单抗治疗不会增加不良反应,且能维持高缓解率和控制率,提升远期生存率,适用于局部晚期头颈部恶性肿瘤患者。

A comparison of malignant fibrous histiocytoma of head, neck and extremities

Objective To compare the epidemiology, local and regional invasion and prognosis of head and neck malignant fibrous histiocytoma (MFH) and extremity MFH Methods Between January 1, 1972 and December 31, 1993, 173 patients with MFH (71 head and neck, 102 extremities and trunk) were referred to the Cancer Hospital for surgical treatment They were 101 men and 72 women, with age ranging from 13 to 83 years (median: 45 years) The extent of surgery was classified into radical, wide and local resection Results For head and neck, local recurrence of MFH after wide resection was 80 4% (37/46), compared with 36.4% (8/22) after radical surgery ( P =0 000) The five year survival was 50 79% in all the head and neck patients (74 75% in patients free of local recurrence, 37 74% in patients with local recurrence; P =0 0181), compared with 70 71% in extremity patients ( P =0 0005) Repeated surgery after recurrence of MFH could cure 40 9% of the head and neck patients and 80 7% of the extremity patients Conclusion Inadequate resection of head and neck MFH in initial surgery is associated with a high incidence of local recurrence, which is always correlated with worse prognosis Repeated surgery for recurrent head and neck MFH is not as effective as for recurrent extremity MFH Therefore, we suggest that the initial surgery for head and neck MFH should be as radical as allowed to avoid a possible local recurrence

头颈部恶性肿瘤根治术后下肢深静脉血栓形成的风险预测模型构建

目的构建头颈部恶性肿瘤根治术后下肢深静脉血栓形成(lower extremity deep venous thrombosis,LDVT)的风险预测模型并探讨其临床价值。方法回顾性纳入2017年1月—2022年12月于徐州市中心医院口腔颌面外科就诊的224例头颈部恶性肿瘤患者,均接受根治手术。根据LDVT发生情况分为发生组(n=24)和未发生组(n=200)。统计两组患者临床信息,通过单因素及多元Logistic回归筛选入组患者围手术期LDVT的独立危险因素,并构建风险预测列线图模型,采用受试者工作特征曲线(receiver operating characteristic,ROC)验证列线图模型的预测效能。结果两组在是否患有高血压、术前是否抗凝治疗、D-二聚体(D-dimer)水平、术后卧床时间和血小板与淋巴细胞比值(platelet/lymphocyte ratio,PLR)有明显差异(P<0.05)。将多元Logistic回归获取的危险因素构建风险预测模型,R语言软件计算模型的曲线下面积(area under curve,AUC)为0.814(95%可信区间0.778~0.849),提示其具有良好的判别和校准效果。决策曲线分析证实,在10%~75%的阈值概率区间内,预测模型的净收益较高。结论基于高血压病史、术前预防性抗凝治疗、D-二聚体水平≥0.5 mg/L、术后卧床≥3 d、血小板与淋巴细胞比值(PLR)≥176来构建的风险预测模型,对头颈部恶性肿瘤并接受根治手术的患者围手术期发生LDVT有良好的风险预测性,可用于提供个体化LDVT风险评估,指导治疗决策,减少LDVT并发症的发生。

MDT和互联网可视化平台在头颈部恶性肿瘤临床教学中的应用

头颈部肿瘤是异质性最高的恶性肿瘤之一,多学科综合诊疗(MDT)是个体化精准诊疗和疾病全程管理的核心。MDT诊疗也是头颈部肿瘤重要的教学模式,但在实际教学中受到时空限制。通过构建基于互联网、医院HIS/PACS/LIS/EMR系统、医疗可视化大屏、口腔内窥镜、远程会诊平台及其他可接入的音视频终端等组成的互联网可视化平台,将其应用于头颈部肿瘤MDT临床教学中,让医学生和临床规培学员通过联网可视化平台参与头颈部肿瘤MDT,深度学习这一异质性最大的恶性肿瘤,为临床医学教学模式提供新的途径。

脂肪间充质干细胞来源外泌体改善放射性口腔黏膜炎

背景:头颈肿瘤放疗极易引起放射性口腔黏膜炎,严重影响患者的健康及肿瘤的治疗计划。间充质干细胞在多种疾病中表现出治疗潜力,外泌体是其发挥功能的重要因素之一。目前尚无脂肪间充质干细胞来源外泌体应用于放射性口腔黏膜炎的相关研究。目的:探讨脂肪间充质干细胞来源外泌体在放射性口腔黏膜炎中的作用。方法:提取脂肪间充质干细胞及脂肪间充质干细胞来源外泌体并进行鉴定。通过3 Gy X射线辐射口腔黏膜上皮细胞诱导放射性口腔黏膜炎体外模型,在造模前给予脂肪间充质干细胞或脂肪间充质干细胞来源外泌体预处理48 h,EdU实验和克隆形成实验检测口腔黏膜上皮细胞的增殖能力。通过3 Gy X射线辐射构建放射性口腔黏膜炎小鼠模型,将脂肪间充质干细胞和脂肪间充质干细胞来源外泌体分别注入放射性口腔黏膜炎小鼠尾静脉,采用苏木精-伊红染色和免疫组化评估口腔黏膜上皮组织的炎症变化。结果与结论:(1)与对照组相比,脂肪间充质干细胞及脂肪间充质干细胞来源外泌体均可促进口腔黏膜上皮细胞克隆形成,增加口腔黏膜上皮细胞EdU阳性率;(2)脂肪间充质干细胞及脂肪间充质干细胞来源外泌体均能够缓解辐射处理小鼠口腔黏膜上皮组织的炎症;口腔黏膜上皮组织中CD45阳性细胞均减少,PCNA阳性细胞均增加。结果表明,脂肪间充质干细胞来源外泌体可促进口腔黏膜上皮细胞增殖,对放射性口腔黏膜炎小鼠口腔黏膜炎症具有缓解作用。

Diagnostische Bedeutung von pentavalenter ^(99m)Tc-Dimercaptobern-steinsure ([V]-DMSA) bei Kopf-Hals-Tumoren

The purpose of this investigation was to assess the biodistribution of 99mTc-[V]-DMSA in human being, and its di- agnostic value in patients with head and neck tumours. 20 patients with histologically confirmed head and neck tumours were ex- amined with planar as well as SPECT scintigraphy. Whole body scintigraphy in different time after injection of 99mTc-[V]-DM- SA was performed to assess the major sequential organ biodistribution. Our results showed that the blood clearance of 99mTc- [V]-DMSA was bi-exponential. All organs except kidneys showed a relatively rapid elimination of 99mTc-[V]-DMSA. The kid- neys showed a increasing accumulation in the first 2 h, which is probably due to the tubular reabsorption of 99mTc-[V]-DMSA. In 15 of 20 patients, 19 lesions could be proven by means of planar scintigraphy (corresponding sensitivity of 75%). 29 lesions in 18 patients could however be detected by the application of SPECT (corresponding sensitivity of 90%). Except primary tumours and local lymphadenmetastases in 5 patients distant metastases (3 thorax wall, 1 liver and 1 inguinal/paravesicle) were found. Altogether a sensitivity of 76. 9% and a specificity of 71. 4% were calculated for the detection of primary tumour. The sensitivi- ty and specificity for the exploration of lymphadenmetastases were 75% and 100%. In conclusion, this study shows that 99m Tc-[V]-DMSA, particularly with SPECT imaging, is useful in localising the primary tumours and lymphadenmetastases as well as distant metastases of head and neck tumours. The possible therapeutic application of 188/186Re-[V]-DMSA is also evaluated.

Sentinel lymph node mapping for malignant melanoma of the external auditory canal

We describe a novel technique for sentinel lymph node mapping and biopsy of a primary cutaneous malignant melanoma in the medial portion of the external auditory canal. The approach is illustrated through a case report and technical description of a procedure performed under general anesthesia on a 19-year-old female patient. Due to the hidden and sensitive location of the primary tumor in the medial external auditory canal, the lymphoscintigraphy injection had to be performed by the surgeon immediately prior to the resection of her c T2 a N0M0 lesion. Final pathology revealed clear margins at the primary site resection and 2 intraparotid sentinel lymph nodes with microscopic foci of metastatic malignant melanoma, which led to further surgical management. A completion left parotidectomy and neck dissection yielded no additional metastatic disease in the fifty-five nodes that were evaluated. Using this technique, sentinel lymph node mapping and biopsy accurately predicted the highest risk lymph nodes for the primary lesion of the medial portion of the external auditory canal.

应用“Bonnet bypass”治疗头颈部巨大恶性肿瘤2例并文献复习

目的探讨“Bonnet bypass”治疗头颈部巨大恶性肿瘤的可行性,评估治疗效果和临床意义。方法回顾分析采用Bonnet bypass方法治疗的2例头颈部巨大恶性肿瘤晚期患者的临床资料。先用Bonnet bypass方法行对侧颈总动脉-同侧大脑中动脉搭桥手术,二期扩大切除头颈部巨大恶性肿瘤;随访观察患者的预后。并对相关文献进行复习。结果2例患者均顺利完成颈内动脉搭桥及根治性肿瘤切除手术。其中1例患者术后4个月肿瘤复发,6个月后搭桥血管闭塞,21个月后因肿瘤进展死亡;另1例患者术后5个月搭桥血管闭塞,12个月肿瘤复发,16个月后因肿瘤进展死亡。结论应用“Bonnet bypass”治疗颈部巨大恶性肿瘤,分期行血管重建和根治性肿瘤切除可以很好地控制局部病变,提高生存质量。

挽救性介入治疗头颈部难治性出血

目的 探讨急诊介入治疗头颈部难治性出血的可行性、安全性及疗效。方法 回顾性总结2016年4月至2021年4月郑州大学第一附属医院介入科收治的86例头颈部难治性出血患者临床资料,男62例、女24例,年龄12~79岁,平均(53.7±15.0)岁。患者均因保守治疗效果差而转行介入治疗。分析患者临床资料、有效止血率、临床成功止血率、住院期间再出血和离院复发原因及并发症。结果 急诊介入治疗有效止血率为96%(83/86),临床成功止血率为91%(79/86),住院期间再出血6例,离院复发12例。术后24 h内几乎所有患者均出现不同程度的口腔颌面部轻微疼痛、肿胀或皮肤色泽改变等栓塞后综合征。1例术后6 h发生右侧大面积脑梗死。随访(3~24个月)期间,7例因再发大出血而死亡,21例因肿瘤进展死亡。结论 介入治疗头颈部难治性出血疗效确切,技术安全、可行,并发症少,能挽救患者生命。

肿瘤治疗电场在头颈部癌症中的应用前景

近年来,随着免疫制剂和分子靶向药物的研发进展,针对恶性肿瘤的治疗取得了一定突破,但其仍然是目前全球疾病死亡的主要原因。肿瘤治疗电场(tumor treating fields,TTFields)是一种全新的非侵入性癌症治疗方法。TTFields可提供给肿瘤局部一个低强度(1~3 V/cm)、中频(100~300 kHz)的交变电场,通过破坏肿瘤细胞有丝分裂期的染色体分离及诱发介电泳现象,使细胞结构紊乱,发生凋亡。TTFields对正常细胞和癌细胞的敏感参数不同,对静止期细胞则没有作用,故其抗肿瘤治疗的毒副作用小、创伤小,具有很大潜力。TTFields的有效性和安全性已在多形性胶质母细胞瘤的Ⅲ期临床试验中得到验证,在其他实体瘤也相继开展了临床研究。本文就TTFields的最新研究进展进行综述,并阐述其微观机制及讨论在头颈癌中的应用前景。

癌症信息超载对头颈部恶性肿瘤放化疗患者恐惧疾病进展的影响:决策冲突的中介作用

目的探讨决策冲突在头颈部恶性肿瘤放化疗患者癌症信息超载(Cancer information overload,CIO)与恐惧疾病进展间的中介作用。方法2022年8月至2023年1月,采用便利抽样法选取承德医学院附属医院肿瘤科收治的241例头颈部恶性肿瘤行放化疗患者作为研究对象,采用一般资料调查表、癌症信息超载量表(cancer information overload scale,CIOS)、决策冲突量表(decisional conflict scale,DCS)、恐惧疾病进展量表(fear of progression questionnaire-short form,FoP-Q-SF)进行调查。结果头颈部恶性肿瘤放化疗患者的CIOS、DCS及FoP-Q-SF的总得分分别为(19.48±8.43)、(30.82±7.66)、(34.92±13.73)分;Pearson相关性分析结果显示,头颈部恶性肿瘤放化疗患者的CIOS与DCS、FoP-Q-SF呈两两正相关(均P<0.01);Bootstrap分析显示,DCS占头颈部恶性肿瘤放化疗患者CIOS和FoP-Q-SF中介效应值的32.19%。结论DCS在头颈部恶性肿瘤放化疗患者CIOS与FoP-Q-SF间起到部分中介作用,提示医务人员可以通过制定系统完善的健康宣教策略提高患者癌症信息素养,以缓解患者CIOS和DCS,从而改善患者FoP-Q-SF心境状态。

基于微信平台的回授法健康教育在头颈肿瘤气管切开患者延续护理中的应用

目的探讨基于微信平台的回授法健康教育在头颈肿瘤气管切开患者延续护理中的应用价值。方法选取2020年1月—2021年11月医院收治的87例行气管切开术后长期置管的头颈肿瘤患者为研究对象,按照组间基本资料具有可比性的原则分为对照组42例和观察组45例。对照组在出院前由责任护士予常规健康宣教和出院指导,出院后定期电话随访。观察组采用基于微信平台的回授法健康教育,连续干预3个月。观察两组患者气道护理知识掌握程度、并发症发生率、生活质量。结果实施基于微信平台的回授法健康教育干预后,观察组对于气道护理知识掌握程度优于对照组,观察组出院后3个月生活质量各维度得分优于对照组,差异均具有统计学意义(P<0.05)。观察组并发症发生率为8.89%,明显低于对照组的26.19%,差异具有统计学意义(P<0.05)。结论基于微信平台的回授法健康教育可有效提高头颈肿瘤气管切开带管出院患者气道护理知识的掌握程度,减少并发症发生,改善患者生活质量。

经口机器人辅助咽后淋巴结清扫术治疗头颈部恶性肿瘤的疗效及预后因素的Cox模型分析

目的:探讨经口机器人辅助咽后淋巴结(retropharyngeal lymph node,RPLN)清扫术治疗头颈部恶性肿瘤的疗效及预后因素的Cox模型分析。方法:选择2017年1月—2019年12月接受诊治且随访至2022年12月的头颈部恶性肿瘤患者68例,均予以经口机器人辅助RPLN清扫术治疗,对比临床缓解率、临床控制率、手术时间、术中出血量、住院时间及随访第1、2、3年的生存率、生存时间。采用SPSS 22.0软件包对数据进行统计学分析。结果:68例头颈部恶性肿瘤患者均顺利完成经口机器人辅助RPLN清扫术治疗,所有患者术后均未出现咽后切口大出血、霍纳综合征及吸入性肺炎等并发症。随访3年,生存时间(31.15±4.93)个月,随访第1年生存率为91.18%(62/68)、第2年生存率为85.29%(58/68)、第3年生存率为70.59%(48/68)。不同性别、年龄、疾病类型、原发病灶、淋巴结包膜外侵犯及周围神经受侵犯的患者,3年生存率相比差异无统计学意义(P>0.05)。不同T分期、N分期、TNM分期、受侵淋巴结最大直径和脉管癌栓的患者3年生存率相比,差异有统计学意义(P<0.05)。Cox比例风险回归模型分析结果显示,T3~4期、N2b~3期、TNM分期为Ⅳb期、受侵淋巴结最大直径>6 cm和脉管癌栓是影响头颈部恶性肿瘤患者术后3年生存率的独立危险因素(P<0.05)。结论:经口机器人辅助RPLN清扫术治疗头颈部恶性肿瘤具有一定疗效,但T分期、N分期、TNM分期、受侵淋巴结最大直径和脉管癌栓等因素会影响患者生存率,临床上应提高重视程度。

基于数据挖掘探讨燕京肿瘤医家秦厚生治疗头颈部恶性肿瘤用药规律

目的基于数据挖掘探讨燕京肿瘤医家秦厚生治疗头颈部恶性肿瘤用药规律。方法自首都医科大学附属北京中医医院病案室名老中医案卷中,筛选秦厚生治疗头颈部恶性肿瘤诊疗医案,采集医案的西医诊断及治疗、中医症状、组方用药信息等建立数据库,并进行描述统计分析、关联规则分析和聚类分析。结果共纳入有效数据170条,接受手术治疗者约54.7%,放疗者约28.5%;带瘤者约78.2%;高频症状为头颈部疼痛(75)、肿物(28)、身痛(27)、憋闷(13)、乏力(11);涉及药物共154味,药物频次居前3位的是功劳叶(85)、黄芩(74)、板蓝根(74);药物类别居于前3位的是清热药(41.9%)、补虚药(12.1%)、解表药(7.1%);药性以寒为主,药味以甘居多,药物归经主入肺经。对高频药物进行关联规则分析和聚类分析。结论对于头颈部恶性肿瘤,秦厚生教授在治疗原则上以清热解毒为主,配以养阴生津,辅以引经药助药上达于头面;在用药方面,喜用既能清热解毒,又可养阴生津的功劳叶,药组如白薇+茵陈+生牡蛎等。