Head and neck cancer chemotherapy, systemic chemotherapy in the past as a single clinical medicine, the lack of effective drugs and programs, and are surgery, radiotherapy recurrence after palliative treatment, efficacy is not satisfactory. With the emergence of more effective anti-cancer drugs, especially lead anticancer drug widely used and the progress of chemotherapy, the current chemotherapy for advanced head and neck cancer has been the attention of clinical workers. Chemotherapy and surgery, radiotherapy combined therapy can improve local control, although so far not yet sufficient evidence that can improve survival, but in some non-randomized clinical trials to improve the quality of life that really good.
1. Single-agent chemotherapy
Single head and neck cancer effective drugs MTX, BLM, CTX ,5-FU, HU, MMC, ADM, and vinca alkaloids, commonly used VCR, VLB, VDS, these drugs ease the rate of about 15% – 30%, but very few CR, the median response of 3-5 months.
(1) methotrexate Ridge (MTIO MTX is the first and one of the most commonly used drugs, then with leucovorin rescue. Generally believed that the use of intravenous administration, each 40–50mg/m2, week 1 , or every 15 .. 20mg / time, 2 times per week, patients can 1/2–1/3 PR, good curative effect than other methods.
(2) bleomycin (BLM) BLM is the second widely used drug, can shrink tumors late, especially oral cancer is better. The appropriate dose is 0.25 – 0.5mg / candle, intramuscular injection or intravenous injection, 1 or 2 times a week. Domestic product Pingyangmycin (PYM), mainly composed of BLM Island, generally using a dose of 8 – 12mg, intramuscular injection or intravenous injection, every 2 – 3 times. ADM Derivatives Peipu BLM pulmonary toxicity Leo smaller head and neck cancer remission rate of 49.8%.
(3) Shun pin (DDP) DDP is currently the most effective treatment of head and neck cancer and the latest drugs, single agent response rate of 27% – 40% in the untreated patients had up to 70%, usually in remission within 6 months. Experiments show that, DDP and radiotherapy has a synergistic effect in combination with radiotherapy has been widely used in advanced patients. Commonly used dose 80-120mg/m2, according to the patient situation, 1 – 3 days given every 3 weeks.
Head and neck cancer chemotherapy (4) caliper (CBP) CBP is the second generation of anticancer drugs uranium, because of its non-hematologic toxicities such as renal toxicity, gastrointestinal reactions, ototoxicity and peripheral neurotoxicity less, you can replace the DDP . Each caliper general 200–400mg/m2, intravenous injection, 1 week; or every 60 – 80mg / time, intravenous injection, 1 time per day for 5 days, 3 – 4 weeks after the duplication, ease 14% – 28%, the median response of 3 – 5 months.
(5) adjacent feeding adriamycin (THP) T field is the chemical structure and similar benefits ADM antitumor antibiotic ring, and its non-hematologic toxicity, such as cardiac toxicity, gastrointestinal reactions, hair loss and other more ADM light, single drug remission rate of 20% – 70%, mainly in the external auditory canal effective part of maxillary sinus, throat and mouth, the main toxicity was myelosuppression. Dose is generally 35–45mg/m2, intravenous injection, every 3 – 4 weeks 1. E clinical trials showed that intravenous infusion into a more efficient and more secure, arterial perfusion can be 5 – 20mg, 3 times a week, cumulative doses less than 100mg, so that the surrounding arterial tissue necrosis. Were effective disease had reached a total of more than 60-70mg and 1 week after discontinuation of treatment.
(6), paclitaxel (taxol, TAX) TAX for the new mitotic inhibitor, with the promotion of microtubule assembly and stability of microtubule function. TAX on the head and neck cancer have a certain effect, the use of 250mg/m2, more than 24 hours infusion, day 3 for patients G-CSF, treatment of 1 every 3 weeks in to comment. Price effect of the 28 cases, CR2 cases, PR10 cases, response rate 40%, the median response of 4 months, the lesion can be seen all the changes, suggesting that the head and neck cancer Taxal is a very promising drug.
2. MDT
Combined with chemotherapy in head and neck cancer with DDP and is divided into two major categories of non-DDP. DDP combined with chemotherapy is superior to single drug, but also better than many non-DDP combination chemotherapy programs. DDP combination chemotherapy in the initial treatment among 40% -70% response rate. The DDP-based combination chemotherapy in the treatment of advanced head and neck cancer is currently being considered the most effective in untreated patients had up to 18% -22% CR. BLM programs, such as response rate ten DDP 71%, CR 19%; added MTX, DDP + BLM + MTX composition program, response rates of up to 50 %—- 90%, but CR did not increase; DDP + 5-FU as effective . Turn on a program to another program is still valid and effective. DDP +5- FU (continuous infusion) program is head and neck cancer, the most effective and safe regimen, CR DDP + BLM was higher than that of any joint programs, nor involved in DDP + MTX and MTX DDP renal excretion of renal toxicity may be fatal interactions. 5-FU infusion increased the time and course of treatment, remission rate and CR rates have increased.
For other pathological types of head and neck cancer, generally based on DDP +5- FU plus CTX, town, MMC, VP-16, ADM or the T field, etc. 2 —– 3 chemotherapy drug to form a coalition. DDP +5- FU-based treatment, the card is mainly uranium combination chemotherapy with 5-FU combination, can also be fixed on 207 instead of 5-FU (continuous transmission discretion, 27% -92% response rate, efficacy and DDP +5- FU (continuous infusion) are similar, the recommended dosage and usage for: caliper 300mg/m2, intravenous infusion, day 1 ,5-FU daily 800mg/m2, continuous infusion, days 1-5, repeated after 4 weeks .
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