头颈部癌症治疗趋势课件.pptVIP

頭頸部癌症治療趨勢 馬偕醫院癌症中心頭頸部癌症小組 耳鼻喉科頭頸外科 呂宜興醫師 George Washington Crile 1864-1943 Surgeon focus on thyroid gland and neck Dutch, Scottish-Irish descent Excision of cancer of the head and neck JAMA 1906; 47: 1780-1788. Treatment of N0 neck Prevalence of occult metastasis: 10% (47% in T1/T2 tongue ca, 40% T2 FOM ca) Supraglottic ca T3N0M0: BND vs no ND, recurrence 7.8% vs 20%, but the same survival rate. SND for N0 of tongue ca: level I, IIa, III Treatment of N0 neck The sensitivity of CT scan (or MRI) in diameter of neck mass: 1.1cm (Radiology 1998;207:123-130) Thickness and local recurrence in N0 of tongue ca: 8mm 49%, 3-7mm 26%, 2mm 0% Local large nerves (lingual and hypoglossal nerves) invaded in tongue ca, then R/T indicated T2N1M0 Treatment: SND level I,II,III +/- XRT or SND I,II,III,(IV,V) Oropharyngeal ca level V 應該做, oral tongue ca 可以不作level V pN1 without ECS 應該可以不用 post OP CCRT Resectable or Curable How to prevent shoulder drop after treatment in p’t of head and neck cancer Preserve SAN (SAN,C2,C3 neuron may be related to the function of shoulder) Avoid dissecting level V L/N Nerve graft after sacrifice SAN Rehabilitation exercise How to reduce the severity of xerostomia IMRT Amifostine drug Submandibular gland transposition (Transposition of the contralateral submaxillary gland to the submental region is proposed as a method for preventing asialia following salivary gland irradiation during radiotherapy for oropharyngeal cancer. The method should be reserved for patients with oropharyngeal cancer without lymph node metastases on the contralateral side.) Submandibular gland transposition All the glands survived transfer and functioned well postoperatively as demonstrated on the salivary flow and the radioisotope studies. The surgical transfer was relatively simple and added 45 minutes to the surgical procedure. There were no complications attributed to the submandibular gland transfer. Laryngoscope. 2001 Fe