放射治疗的原则.doc
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参见附件(64KB)。
放射治疗的原则
* 同步化疗(首选)
常规分割1
原发灶和密集的肿大淋巴结
≥70 Gy (2.0 Gy/day)
颈部未受侵淋巴结
44-50 Gy (2.0 Gy/day)
* 没有同步化疗的根治性放疗(不宜化疗或拒绝化疗的病人)
对于首选单独放疗的可改变分割方式(超分割或推量)
超分割：81.6 Gy/7 周 (1.2 Gy/次 两次/日)
推量后程加速放疗: 72 Gy/6周(1.8 Gy/次, 大野;最后12个治疗日时,1.5 Gy推量作为每日第二次照射)
常规分割: 原发灶和腺病区70 Gy (2.0 Gy/day)
_颈部未受累淋巴引流区50 Gy (2.0 Gy/day)
* 根治性放疗+西妥西单抗(c225,病人不能耐受化疗毒性的选择)
* 放疗技术
三维适形技术可以被使用在有经验(受训)的医生和物理师支持的肿瘤治疗中心,调强放疗技术在NCCN协会和其他地区中是一个积极发展的领域。在头颈影像上，靶区勾画和最佳剂量分布要求专门的训练，对本病扩散的方式应非常清楚，调强放疗技术需专业培训。靶区的定义、剂量的规范、分割的方式(有无同步化疗)、正常组织的保护，系列标准将在随后的几年中出现。
1同步放化疗的经验多数采用发表的刊物:利用常规放疗(2.0 gy/次至 70 Gy ,7周内 )和单药顺铂100 mg/m 2,三周一次.使用其它分割方式(如, 1.8 Gy, 常规),多药化疗或化疗联合改变的分割方式不被评估为最佳方式.总的说来,同步放化疗带来了较高的毒副反应----改变分割方式或多药化疗将出现毒副反应更严重.
对于任何报道的同步放化疗的方法，它的化疗方案、剂量，治疗安排都要特别小心 。放化疗应该被有经验的团队和完备的支持治疗保证来完成。
ADV-A
全身治疗的原则(Page 1 of 2)
化疗的选择将是基于患者个体差异的个体化治疗(包括身体状态、治疗目的)
鳞癌：上颌窦、筛窦、唇、口腔、口咽、喉咽、声门、声门上、原发灶不明。
首程全身化疗+同步放疗
* 顺铂单药(首选)1，2
* 5-FU/羟基脲3
* 顺铂/紫杉醇3
* 顺铂/持续输注5-FU3，4
* 卡铂/持续输注5-FU5
* 西妥西单抗6
术后放化疗
* 顺铂单药7~9
诱导化疗(随后放化疗)
* 多西他赛\顺铂\5-FU10,11
鼻咽癌
放化疗后辅助化疗
* 放疗+顺铂,随后顺铂/5-FU12
CHEM-A
参考文献见CHEM-A(2of 2)
CHEM-A(1 of 2)
全身治疗的原则(Page 2of 2)
参考文献
1 ：Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med
2003;349:2091-8.
2 ：Adelstein DJ, Li Y, Adams GL, et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy
in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 2003;21(1):92-98.
3 Garden AS, Harris J, Vokes EE, et al. Preliminary results of Radiation Therapy Oncology Group 97-03: A randomized phase II trial of concurrent radiation
and chemotherapy for advanced squamous cell carcinomas of the head and neck. J Clin Oncol 2004;22:2856-2864.
4：Gibson MK, Li Y, Murphy B, et al. Randomized phase III evaluation of cisplatin plus fluorouracil versus cisplatin plus paclitaxel in advanced head and neck
cancer (E1395): An Intergroup Trial of the Eastern Cooperative Oncology Group. J Clin Oncol 2005;23(15):3562-3567.
5：Denis F, Garaud P, Bardet E, et al. Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing
radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol 2004;22(1):69-76.
6：Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous cell carcinoma of the head and neck. N Engl J Med 2006;354:567-78.
Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head
and neck. N Engl J Med 2004;350:1937-44.
7：Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous cell carcinoma of the head and neck. N Engl J Med 2006;354:567-78.
Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head
and neck. N Engl J Med 2004;350:1937-44.
8：Bernier J, Domenge C, Ozsahin M, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer.
N Engl J Med 2004;350:1945-52.
9：Bernier J, Cooper JS, Pajak TF, et al. Defining risk levels in locally advanced head and neck cancers: A comparative analysis of concurrent postoperative
radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005;27:843-850.
10：Schrijvers D, Van Herpen C, Kerger J, et al. Docetaxel, cisplatin and 5-fluorouracil in patients with locally advanced unresectable head and neck cancer:
a phase I-II feasibility study. Annals of Oncology 2004;15:638-645.
11 Vermorken JB, Remenar E, Van Herpen C, et al. Standard cisplatin/infusional 5-fluorouracil vs docetaxel plus PF as neoadjuvant chemotherapy for
nonresectable locally advanced squamous cell carcinoma of the head and neck: A phase III trial of the EORTC Head and Neck Cancer Group. J Clin
Oncol 2004 Proc Amer Soc Clin Oncol;22(14S)[Abstr. 5508].
12：Al-Sarraf M, LeBlanc M, Giri PG, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized
Intergroup study 0099. J Clin Oncol 1998;16:1310-1317.
13：Forastiere AA, Metch B, Schuller DE, et al. Randomized comparison of cisplatin plus flurouracil and carboplatin plus fluorouracil versus methotrexate in
advanced squamous cell carcinoma of the head and neck: A Southwest Oncology Group Study. J Clin Oncol 1992;10(8):1245-1251.
14 Burtness B, Goldwasser MA, Flood W, et al. Phase III randomized trial of cisplatin plus placebo versus cisplatin plus antiepidermal growth factor-receptor
antibody cetuximab in metastatic/recurrent head and neck cancer: An Eastern Cooperative Oncology Group Study. J Clin Oncol (In press).
15 Trigo J, Hitt R, Koralewski P, et al. Cetuximab monotherapy is active in patients with platinum-refractory recurrent/metastatic squamous cell carcinoma of
the head and neck: results of a phase II study. J Clin Oncol 2004 Proc Amer Soc Clin Oncol ;22(14S)[Abstr. 5502].
CHEM-A(2 of 2)
放射治疗的原则
* 同步化疗(首选)
常规分割1
原发灶和密集的肿大淋巴结
≥70 Gy (2.0 Gy/day)
颈部未受侵淋巴结
44-50 Gy (2.0 Gy/day)
* 没有同步化疗的根治性放疗(不宜化疗或拒绝化疗的病人)
对于首选单独放疗的可改变分割方式(超分割或推量)
超分割：81.6 Gy/7 周 (1.2 Gy/次 两次/日)
推量后程加速放疗: 72 Gy/6周(1.8 Gy/次, 大野;最后12个治疗日时,1.5 Gy推量作为每日第二次照射)
常规分割: 原发灶和腺病区70 Gy (2.0 Gy/day)
_颈部未受累淋巴引流区50 Gy (2.0 Gy/day)
* 根治性放疗+西妥西单抗(c225,病人不能耐受化疗毒性的选择)
* 放疗技术
三维适形技术可以被使用在有经验(受训)的医生和物理师支持的肿瘤治疗中心,调强放疗技术在NCCN协会和其他地区中是一个积极发展的领域。在头颈影像上，靶区勾画和最佳剂量分布要求专门的训练，对本病扩散的方式应非常清楚，调强放疗技术需专业培训。靶区的定义、剂量的规范、分割的方式(有无同步化疗)、正常组织的保护，系列标准将在随后的几年中出现。
1同步放化疗的经验多数采用发表的刊物:利用常规放疗(2.0 gy/次至 70 Gy ,7周内 )和单药顺铂100 mg/m 2,三周一次.使用其它分割方式(如, 1.8 Gy, 常规),多药化疗或化疗联合改变的分割方式不被评估为最佳方式.总的说来,同步放化疗带来了较高的毒副反应----改变分割方式或多药化疗将出现毒副反应更严重.
对于任何报道的同步放化疗的方法，它的化疗方案、剂量，治疗安排都要特别小心 。放化疗应该被有经验的团队和完备的支持治疗保证来完成。
ADV-A
全身治疗的原则(Page 1 of 2)
化疗的选择将是基于患者个体差异的个体化治疗(包括身体状态、治疗目的)
鳞癌：上颌窦、筛窦、唇、口腔、口咽、喉咽、声门、声门上、原发灶不明。
首程全身化疗+同步放疗
* 顺铂单药(首选)1，2
* 5-FU/羟基脲3
* 顺铂/紫杉醇3
* 顺铂/持续输注5-FU3，4
* 卡铂/持续输注5-FU5
* 西妥西单抗6
术后放化疗
* 顺铂单药7~9
诱导化疗(随后放化疗)
* 多西他赛\顺铂\5-FU10,11
鼻咽癌
放化疗后辅助化疗
* 放疗+顺铂,随后顺铂/5-FU12
CHEM-A
参考文献见CHEM-A(2of 2)
CHEM-A(1 of 2)
全身治疗的原则(Page 2of 2)
参考文献
1 ：Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med
2003;349:2091-8.
2 ：Adelstein DJ, Li Y, Adams GL, et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy
in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 2003;21(1):92-98.
3 Garden AS, Harris J, Vokes EE, et al. Preliminary results of Radiation Therapy Oncology Group 97-03: A randomized phase II trial of concurrent radiation
and chemotherapy for advanced squamous cell carcinomas of the head and neck. J Clin Oncol 2004;22:2856-2864.
4：Gibson MK, Li Y, Murphy B, et al. Randomized phase III evaluation of cisplatin plus fluorouracil versus cisplatin plus paclitaxel in advanced head and neck
cancer (E1395): An Intergroup Trial of the Eastern Cooperative Oncology Group. J Clin Oncol 2005;23(15):3562-3567.
5：Denis F, Garaud P, Bardet E, et al. Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing
radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol 2004;22(1):69-76.
6：Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous cell carcinoma of the head and neck. N Engl J Med 2006;354:567-78.
Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head
and neck. N Engl J Med 2004;350:1937-44.
7：Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous cell carcinoma of the head and neck. N Engl J Med 2006;354:567-78.
Cooper JS, Pajak TF, Forastiere AA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head
and neck. N Engl J Med 2004;350:1937-44.
8：Bernier J, Domenge C, Ozsahin M, et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer.
N Engl J Med 2004;350:1945-52.
9：Bernier J, Cooper JS, Pajak TF, et al. Defining risk levels in locally advanced head and neck cancers: A comparative analysis of concurrent postoperative
radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005;27:843-850.
10：Schrijvers D, Van Herpen C, Kerger J, et al. Docetaxel, cisplatin and 5-fluorouracil in patients with locally advanced unresectable head and neck cancer:
a phase I-II feasibility study. Annals of Oncology 2004;15:638-645.
11 Vermorken JB, Remenar E, Van Herpen C, et al. Standard cisplatin/infusional 5-fluorouracil vs docetaxel plus PF as neoadjuvant chemotherapy for
nonresectable locally advanced squamous cell carcinoma of the head and neck: A phase III trial of the EORTC Head and Neck Cancer Group. J Clin
Oncol 2004 Proc Amer Soc Clin Oncol;22(14S)[Abstr. 5508].
12：Al-Sarraf M, LeBlanc M, Giri PG, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized
Intergroup study 0099. J Clin Oncol 1998;16:1310-1317.
13：Forastiere AA, Metch B, Schuller DE, et al. Randomized comparison of cisplatin plus flurouracil and carboplatin plus fluorouracil versus methotrexate in
advanced squamous cell carcinoma of the head and neck: A Southwest Oncology Group Study. J Clin Oncol 1992;10(8):1245-1251.
14 Burtness B, Goldwasser MA, Flood W, et al. Phase III randomized trial of cisplatin plus placebo versus cisplatin plus antiepidermal growth factor-receptor
antibody cetuximab in metastatic/recurrent head and neck cancer: An Eastern Cooperative Oncology Group Study. J Clin Oncol (In press).
15 Trigo J, Hitt R, Koralewski P, et al. Cetuximab monotherapy is active in patients with platinum-refractory recurrent/metastatic squamous cell carcinoma of
the head and neck: results of a phase II study. J Clin Oncol 2004 Proc Amer Soc Clin Oncol ;22(14S)[Abstr. 5502].
CHEM-A(2 of 2)
附件资料：
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