肿瘤总论 PPT课件.ppt

1、口腔颌面部肿瘤总论(二),季 彤 上海第二医科大学 口腔医学院 附属第九人民医院 口腔颌面外科,口腔颌面肿瘤的治疗 治疗原则 治疗方法 手术、放射治疗 、化疗、生物治疗、其它 口腔颌面肿瘤的预防,口腔颌面部肿瘤的治疗,治疗原则 综合治疗 个体化方案（individualization）因人因病量体裁衣根治外科和功能外科并重,良性肿瘤：手术治疗,恶性肿瘤：综合序列治疗combined and sequential therapy 化疗手术放疗其它 根据组织来源、细胞分化程度、肿瘤生长部位、临床分期(TNM)及全身情况选择,组织来源 来源不同，治疗方法不同 上皮来源间叶来源 淋巴造血系统 骨肉瘤,

2、细胞分化分化好手术分化差放、化疗 生长部位颅底、深部、重要结构功能障碍面部、皮肤、颌骨肿瘤手术,临床分期 早期 晚期综合治疗 TNM分期(UICC) 全身情况,口腔颌面部肿瘤的治疗方法,手术治疗(Surgery) 根治术与功能外科的概念，无瘤原则 放射治疗(Radiation therapy) 化疗(Chemotherapy) 生物治疗(Biotherapy) 免疫治疗(Immunotherapy),手术治疗原则,明确诊断 明确手术作用，制定合理治疗方案 诊断，探查，治愈，姑息，修复重建，预防 全面考虑，选择合理术式 保存性功能性外科 (conservative functional surg

3、ery) 修复性功能性外科 (reconstructive functional surgery),防止医源播散 无瘤原则 切缘在正常组织内 整块切除（en bloc） 避免挤压 肿瘤表面纱布覆盖 使用电刀 冲洗更换器械 根治与功能并重,Tongue Reconstruction,Mandible Reconstruction,Radiation Therapy,Prof. Rontgen X ray Prof. Marie Curie Radium element Definition ionizing radiation Component of multi-modality therap

4、y Increasing use for head and neck cancer,Principle Radiation sensitive Types of radiation therapy External beam(外照射) vs. Brachytherapy(腔内照射) Common complications,General Principle,Basis ionizing(电离) particles interact with cellular molecules Damages DNA impossible for the cells to grow Damages both

5、 cancer and normal cells, the latter are able to repair themselves,Used to: Combined or as single modality Treat localized tumors Treat leukemia and lymphoma Rapidly dividing cell populations are the most sensitive to radiation tumors, epithelial cells, hemopoietic cells(造血细胞),Radiobiology,External

6、beam,Electron linear accelerator 直线加速器,Gamma rays(Co60),Radium “needles”,After loading,Brachytherapy Internal radiotherapy,Treatment plan system,Complications,Acute Tissue Reactions Late Tissue Reactions,Acute Toxicity,Mucosal reactions 2nd week of XRT Mucositis Skin reactions 5th week Generally sub

7、side several weeks after completion of treatment,Late Toxicity,Injury tends to be permanent Develop within months to years Xerostomia(口干症), radionecrosis of bone, dental caries, fibrosis, soft-tissue necrosis, nerve tissue damage,Chemotherapy,One of the main technologies against cancer Definition No

8、t curative, used only as an adjunct First applied in 1946,Used to: Cure cancer Control cancer Relieve symptoms cancer can cause Usually used in addition with the other treatments,Can be given: At home Dr.s office Clinic Outpatient dept. As an inpatient in a hospital,Classification of chemotherapy dr

9、ugs Chemical structure cell cycle the drug interrupts Protocol of chemotherapy mono drug and combination drug Side effect of chemotherapy,Cell and Tumor Kinetics G1synthesis RNA SDNA synthesis G2synthesis of mitotic spindle G0rest Mmitosis,Chemotherapeutic Agents,Alkylating agents(烷化剂) Antimetabolit

10、es(抗代谢类) Antitumor Antibiotics(抗生素) Steroid hormones(激素类) Plant Alkaloids(植物类),Alkylating Agents,Link to DNA bases stop replication Nitrogen Mustards, HN2 Cyclophosphamide, CTX,Antimetabolites,Inhibit synthesis of bases Methotrexate 5-Fluorouracil,Antitumor antibiotics,Pingyangmycin Bleomycin Adriam

11、ycin Mitomycin Actinomycin D,Hormones,Prednisone Estrogen Testosterone,Plant Alkaloids,Disrupt mitotic spindle during M phase(cell cycle phase specific) Vinca Alkaloids Camptothecins Taxanes,Cell Cycle,Cell Cycle Specific Agents Antimetabolites Bleomycin Podophyllin Alkaloids Plant Alkaloids,Cell Cy

12、cle Non-Specific Agents Alkylating Agents Antibiotics Cisplatin Nitrosoureas,Chemotherapy Protocol,Often combination of agents Different modes of action Reduced chance of resistance Reduced toxicity Often combined with other treatments (Adjuvant) Pre Reduce tumour load Post Reduce sub-clinical disea

13、se,Combination Chemotherapy more effective than single agent additive antitumor effects without additive host toxicity delayed resistance to drugs Use Rapidly dividing tumours most susceptible Balance between efficacy and toxicity,Side effect of chemotherapy,myelosuppression, low blood cell counts g

14、astrointestinal tract problems hair loss skin rashes fatigue infertility,Erythema（红斑）,Hairy tongue,Candidiasis(念珠菌病),Biotherapies or Immunotherapy (免疫治疗) Cryotherapy (低温治疗) Laser Surgery (激光外科) Thermotherapy (加热治疗) Chinese Medicine (中医药治疗) Gene Therapy(基因治疗),Immunotherapy (active) Non-specific bacil

15、lus Calmette-Guerin(mycobacteria) interferons interleukins Specific tumor cell vaccines gene therapy Passive Immunotherapy monoclonal antibodies,Laser Surgery,Naked DNA,Target Cell,Therapeutic Protein,AAV,Retrovirus/Lentivirus,Adenovirus,Nucleus,Gene Therapy Principles,Prevention of oral & maxillofacial tumor,Delete the risk factor Treatment of precancerous lesion Anticancer propaganda,Leukoplakia,Lichen