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化疗是局部晚期头颈癌的重要治疗手段之一,但其使用方案仍待探讨。联合应用顺铂与5-氟尿嘧啶一直被视为标准新辅助治疗,并被证明有利于保存手术患者的器官,提高可手术切除及不可手术切除患者的远期生存效果。新近的研究发现,在顺铂与5-氟尿嘧啶的标准诱导化疗中增加紫杉烷(taxane)、多烯紫杉醇(docetaxel)或紫杉醇(paclitaxel),可进一步改善有效率和生存结果。越来越多的Ⅲ期临床试验资料支持在顺铂与5-氟尿嘧啶的标准诱导化疗方案中增加多烯紫杉醇或紫杉醇,使之成为疗效更好、毒性更小的诱导化疗方案。将诱导化疗与同期化放疗结合的序列治疗方案也在研究之中,旨在进一步提高远期生存效果。在顺铂与5-氟尿嘧啶方案中增加多烯紫杉醇或紫杉醇的诱导方案也在评价之中,序列治疗方案与标准治疗的疗效比较的随机试验也在进行中,有望为局部晚期头颈癌患者提供新的治疗方案。
Chemotherapy is one of the important treatment of locally advanced head and neck cancer, but its use remains to be explored. Combined use of cisplatin and 5-Fluorouracil has long been regarded as a standard neoadjuvant therapy and has been shown to be beneficial in preserving organs of surgical patients and improving the long-term survival of patients with operable or unresectable surgery. Recent studies have found that adding taxane, docetaxel or paclitaxel to cisplatin and 5-fluorouracil standard induction chemotherapy can further improve the efficiency and survival outcomes. More and more phase III clinical trial data support the addition of docetaxel or paclitaxel to standard induction chemotherapy regimens of cisplatin and 5-fluorouracil, making it a more effective and less toxic chemo-regimen. Sequential treatment regimens that combine induction chemotherapy with concurrent radiotherapy are also under investigation to further improve long-term survival. Induction protocols for increasing docetaxel or paclitaxel in cisplatin and 5-fluorouracil regimens are also under evaluation, and randomized trials comparing sequential regimens with standard regimens are underway and are expected to provide new patients with locally advanced head and neck cancer Treatment program.