Surgical operation with put to treat is a temple neck cancer of main treatment method, regarded surgical operation treatment as principle in early days, won a later period to mostly adopt to project a treatment.However, though surgical operation technique, put to treat equipments and technique are continuously improving, 40 in the last years temple neck cancer treatment effect without root exaltation, total 5 year, the existence rate still about 50% on the prowl.
The main reason of the temple neck cancer treatment failure is a tumor part and control or relapse, have 60% ～s 70% around, is a secondly lymphoid knot to transfer with the distance transfer.So, we think, raise a temple neck the treatment effect of the cancer further and still the beard emphasize a temple neck the comprehensive treatment of the cancer.
Along with the development of science technique, medical science science, take place tumor a development and spread the understanding of transfer the regulation is continuously deepenning.Surgical operation with put to treat is the two greatest meanses which cure a temple neck a cancer, all aim at temple neck at first deliver cooking stove, temple side triangle area and district pour a flattering treatment.The part treatment means obviously has no command over the tumor peripheral naked eye unseen and second clinical focus and probably existent whole body second clinical transfer cooking stove.In great quantities clinical fulfillment, make people clearly know limit of single treatment method sex, enhanced the whole idea of tumor treatment thus, break traditional treatment mode, continuously investigate reasonable of comprehensive cure a new method.
American national cancer center(NCI) declares toward the whole world in February, 1999, affirmed to put, chemotherapy of comprehensive under medical treatment later period temple neck the curative effect of the cancer, and put forward an any temple neck which accepts to project a treatment cancer sufferer, all should give chemotherapy.
Temple neck cancer of comprehensive the treatment is head for the clinical research that the norm turn and put in the meantime, the chemotherapy is comprehensive the application be a temple neck in recent years the cancer cure of new strategy, will become medium later period temple neck cancer of standardize and cure mode.
Along with the quick development of chemistry treatment, the new medicine continuously flows out now and the chemotherapy also doubly is valued in the position of the temple neck cancer under medical treatment.At the same time, put, chemotherapy of theories foundation also in the gradual formation.The in great quantities clinical fulfillment express:
① Twos combine has already been in conjunction with a function;
The ② chemotherapy can repress to project to hurt cell of repair, can make the tumor cell synchronize;
The ③ chemotherapy medicine,such as the new medicine Jian Ze, Tuo of the DDP, 5 － Fus, MMC, BLM and the recent years, rush toward the etc. not only have already killed ability of put out the tumor cell, but also have already increased a quick function towards putting to treat for the Kang;
The ④ doesn't prolong to put to treat fulfillment and the complications is without the obvious increment.
How carry on a temple neck a cancer of comprehensive the treatment be a domestic and international scholar to study of a little bit hot, is also a tough crux topic.Though the United States, Canadian etc. country 5 random IIIs expect the clinical trial to acquire can pleased result, affirmed to put in the meantime, chemotherapy under medical treatment, later period temple neck the curative effect of the cancer, treat a project towards put, quantity and chemotherapy medicine, the best project of choice etc., still need further quest.Can say up to the present, still neither with the result that, the comprehensive treatment project of norm, the local circumstance then is more inferior to.
The temple neck cancer treatment exists complicated problem:
The ① temple neck cancer although other tumors easily diagnosed in early days, medium, later period the sufferer still had most and the temple neck cancer only had 1% ～s 20% in early days.
The ② temple neck cancer cent expects to adopt a FIGO clinical cent to expect.Currently everyplace, each doctor's diagnosis level contain difference, the image learns etc. assistance to check still can't widespread usage, the check explains as a result each difference, even do to visit patients at home to break also can't conduct and actions change clinical cent expect of basis.And CT etc. the check basin, belly cavity lymphoid knot transfer of the sensitivity be not high;The PET checks sensitivity although Gao, local application again few.There is report way point out, when the partial later period temple neck cancer carries on surgical operation to expect for cent, discover before the Shu the CT examine the lymphoid knot transfer of the masculine gender rate is only 35%, surgical operation cent had 43% cases to change a treatment project after expect, this elucidation included the temple neck of very high comparison a cancer clinical cent expect to divide to expect to not agree with with surgical operation.Because the clinical cent expects to be not accurate, influenced to cure a project of establishment and treatment effect, past someone lay claim to a temple neck a cancer and should carry on surgical operation to expect for cent, so that the more accurate evaluation basin, belly cavity be lymphoid to knot condition and make treatment more individuation.
③ Why equally expect do not, the pathologic type of same with divide degree, same treatment method, result but dissimilarity of its treatment, investigate its reason, very complicated, probably and the tumor is to the sensitivity which puts to treat, individual of immunity function, mental state, mental factor etc. be closely related.This kind of individual difference goes to in the treatment to can't understand thoroughly, as a result want to attain real treat separately not greatly possible.Cultural heritage report way, combine writer experience, put forward following viewpoint and suggestion to the comprehensive treatment of temple neck cancer.
The purpose of comprehensive treatment and adapt a certificate:
Comprehensive treatment aim at exaltation basin control rate with partial chamber, the decrease relapses and transfers, raise for 5 years, existence rate, mainly be applicable to the temple neck cancer(I b 2 ～ IVs expect), companion in partial later period to divide bad tumor or different and second type the temple neck gland cancer etc. of treatment.The method lends support to a treatment after include before the Shu lend support to treatment and Shu.
(1)Lend support to a treatment before the Shu:Included to put to treat before the Shu or chemotherapy(NAC), often adopted to put to treat before the Shu.The assistance cures before the Shu of purpose:
The ① contracts a lump body and be advantageous to tumor of complete cut off;
The ② lowers cancer cell vitality, in the decrease Shu of sow to spread and the Shu transfer behind;
The ③ removes the naked eye unseen and second clinical focus, the decrease relapse of potential danger;
The ④ improves a partial circumstance, the exaltation surgical operation excision rate;
The ⑤ lately lends support to a chemotherapy in addition to above advantage, return because the tumor afferent bed hasn't break, the chemotherapy medicine easily get into a lump body, can raise tumor's reaction for chemotherapy, exterminate tiny cooking stove to transfer, decrease Shu behind transfer.The assistance cures before the Shu of orientation certificate:Mainly used for a temple neck, cancer in early days had to prepare behind badly the tall Wei sufferer of factor, such as the I b in partial later period 2 ～ II a period;The histology divides bad tumor;The temple neck of the temple neck gland cancer, gland scale cancer, sticky special type of the liquid gland cancer, cellule cancer...etc. cancer etc..
(2)The Shu lends support to a treatment behind:Include to put to treat with chemotherapy, have another with the body outside puts to treat for lord.The Shu lends support to the purpose of treatment behind:
The shortage of the ① complement surgical operation treatment raise a partial control rate;
The ② decrease relapses and transfers, improvement existence.
The Shu lends support to the orientation certificate of treatment behind:
① Basin chamber lymphoid knot assignor;
The ② surgical operation slices good luck to have a survive cancer;
The ③ vagina cuts off scope not enough thoroughly;
The ④ companion has already prepare behind badly factor, such as partial tumor big, the temple neck deep department quality encroach upon and the hair thin afferent and lymphoid cleft be invade(LVS) etc..
The principle of comprehensive treatment:
(1)Partial later period of earlier period temple neck cancer:(I b 2~ II as expect)Lent support to cure to put to treat inside main adoption chamber before the Shu.( the quantity put to treat amount of inside chamber for the whole distance of 1/3~1/2)The pathology turns for the low mark and the proper assistance put to treat to add a chemotherapy before the Shu.(2 treat a distance)If gland cancer companion partial huge piece type or bucket form temple neck, can in advance the whole distanceses put to treat+the chemotherapy juniors go the Jin whole hysterectomieses outside the film.
(2)Partial later period of medium later period temple neck cancer:(II b~the IV expect)Adopt to put in principle, the comprehensive treatment project of chemotherapy;The temple side conglomeration type encroach upon or lymphoid knot the assignor can annex a proper form to adjust strong put to treat to increase partial amount of, have already helped exaltation curative effect.
Put a choice of treat the technique and chemotherapy project:
Partial later period the temple neck cancer lymphoid knot transfers rate Gao.The basin, belly cavity lymphoid knot transfers after obvious influence prepare, the body which hints that we need to change to traditionally and only be limited by a chamber outside puts to treat mode and put to treat scope proper include the Ka total next and lymphoid district of the stomach aorta.Transfer such as the Ka total lymphoid knot, the stomach aorta side project light upon wild should extend to the chest 12, the emanation amount of should depend on concrete circumstance.
Concerning the choice of the chemotherapy medicine and the project, to temple neck cancer effectively with put to treat to increase quick medicine to have:The DDP, 5 － Fus, MMC, BLM, different wreath Lin Mao An IFO, Tai vegetable(Taxol), Tuo rushes toward to choose(Gemcitabine) for the Kang(Topotecan), Jian etc..The more and applied chemotherapy project contains PVB(PDD+VCR+BLM), PBM(PDD+BLM+MMC), BIP(BLM+IFO+Mensa+PDD), FIP(5 － Fus+IFO+Mensa+PDD)...etc..Give the medicine path generally adopt vein whole body to infuse to note to the medicine and the artery of get involved a method.
The our country is a temple neck cancer Gao Fa nation of a, Fu lump scholar already backlog abundant experience.The writer suggests a temple neck cancer of comprehensive the treatment should be in line with nations, is led long a head by domestic a few tumor treatment centers, organize a random prospect clinical research, take acquiring more as dependable data and make temple neck cancerous of comprehensive treatment project day attain perfect.Temple neck cancer of clinical cent expect necessity emendation perfect, the suggestion probably adopts surgical operation pathologic cent expect.In addition combine currently local condition, put forward the following what time to should be to the attention:
(1)The comprehensive treatment isn't a few blindnesses of methods to fold to add.Should there is plan ground carrying on a reasonable design before cure, avoid two kinds of consociation usages which cure for good a method, with the result that produce more complications.
(2)Put to treat before the Shu or the chemotherapy be in order to plannedly cure for good Shu to do preparation, putting to treat amount of should not lead Gao and the chemotherapy treats a distance and should not be excessive.Shu's putting to treat an aim behind is add the shortage of surgical operation, the lymphoid knot which is limited by a chamber transfer, temple side masculine gender etc., should adopt after the Shu the body outside puts to treat, it the amount of depend on circumstance.Incline toward the whole body transfer of high Wei factor sufferer, with after the Shu chemotherapy is proper.
(3)The comprehensive treatment is the trend that the modern tumor cure, but not all temple neck the cancer all needs to adopt a comprehensive treatment.Put to treat or chemotherapy and surgical operation, chemotherapy with put to treat how etc. synthesize, need to carry on more prospect random study, with verify the superiority that it synthesizes a treatment, still need to be investigate in the meantime other comprehensive treatment method, if put to treat to treat with heat etc..
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