口腔癌_treatment_protocol修訂_990901

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WORK-UPCLINICAL

STAGINGPRIMARY TREATMENT PATHOLOGIC FINDINGS ADJUVANT TREATMENT FOLLOW-UP

#(1): $ old age, impaired renal function, poor condition%&RT alone.CCRT: concurrent chemoradiotherapy ( Cisplatin , 100mg/m2 in

weeks 1, 4, 7 or Cisplatin, 30-40mg/m2/week )(2): SND:selective neck dissection

Oral Cavity Cancer KVGH Cancer Center Clinical Practice Guidelines (2010 Version I)

T1N0 Excision of primary or RT

T2N0

T3-4aN0

T/N risk features (-) 0- 3 years

after treatmentpost-treatmentbaseline MRI

within 6 months

of treatment

every 3 months:physical exam

every 1 year:

head and neck

MRI.chest X-ray, bone

scan andabdominal sono as

clinically

indicated.

' 3-5 yearsafter treatmentevery 4-6 months:

physical exam

' 5 years laterafter treatmentevery 6-12months:physical

exam

Excision of primary or RT T/N risk features (-)

Excision of primary

+ unilateral or

ilateral SND, #(2)

N0 and T/N risk features (-)

N1 and T/N risk features (-)

N2() or and T/N risk features (+)

Adjuvant RT >60Gy

CCRT (RT 66-74Gy),#(1)

Excision of primary No T risk features Adjuvant RT >60Gy

Excision of primary

+ unilateral or

ilateral SND, #(2)

N0, T risk features (-)

N1, T/N risk features (-)

Adjuvant RT >60Gy

N2() or perineural /lymphovascular invasion

Adjuvant RT >60Gy or

CCRT (RT 66-74Gy) ,#(1)

Histor

Physical exam

Biopsy

Chest X-ray

MRI or CT ofhead and neck

Bone scan

Abd. sono

Panorex/dental

X-ray

Multidisciplinary

consultation

T risk features: close or postive margins, perineural or lymphovascular invasion.

N risk features: extracapsular spread (ECS)

ECS (+) and/or positive

marginsCCRT (RT 66-74Gy) ,#(1)


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WORK-UP CLINICAL STAGING PRIMARY TREATMENT PATHOLOGIC FINDINGS ADJUVANT TREATMENT FOLLOW-UP

#(1): $ old age, impaired renal function, poor condition%& RT alone.(2): SND:selective neck dissection RND: radical neck dissection

(3): Adjuvant chemotherapy: Cisplatin , 20mg/m2 + 5-FU , 1000 mg/m2 x 5 days ; repeat every 4weeks x 3 courses

Oral Cavity Cancer KVGH Cancer Center Clinical Practice Guidelines (2010 Version I)

Histor

Physical exam

Biopsy

Chest X-ray

MRI or CT ofhead and neck

Bone scan

Abd. sonoPanorex/dental

X-ray

Multidisciplinary

consultation

Respectable T,

N1 (mobile)

Excision of primary

+ ipsilateral SND or RND

contralateral SND,#(2)

Excision of primary

+ ipsilateral RND

contralateral SND,

#(2)

Respectable T,

N1 (fixed)

or

Resectable T,

N2-3

T2()*N1 withoutT/N risk features

Adjuvant RT >60Gy

T2()*N2() orperineural /

lymphovascular invasion

CCRT (RT 66-74Gy) ,#(1)

Respectable, but

poor medical orpoor surgical risk or

patient preference

CCRT

adjuvant chemotherapy,

#(3)

Unresectable Palliative chemotherapy

and supportive care

follow-upprogram as

above

T risk features: close or postive margins, perineural or lymphovascular invasion.

N risk features: extracapsular spread.

T2()* ECS (+) and/orpositive margins

Adjuvant RT >60Gy


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Reference:1.NCCN clinical practice guidelines in oncology. V.2.2010

2.AJCC (American Joint Committee on Cancer) Manual for Staging of Cancer, 7th ed, Greene, FL, Page, DL, Fleming, ID, et al (Eds), Springer-

Verlag, New York 2010.

3.Chen, YK, Huang, HC, Lin, LM, Lin, CC. Primary oral squamous cell carcinoma: an analysis of 703 cases in southern Taiwan. Oral Oncol 1999;35:173.

4.Iro, H, Waldfahrer, F. Evaluation of the newly updated TNM classification of head and neck carcinoma with data from 3247 patients. Cancer 1998;83:2201.5.Bradley, PJ, MacLennan, K, Brakenhoff, RH, Leemans, CR. Status of primary tumour surgical margins in squamous head and neck cancer:

prognostic implications. Curr Opin Otolaryngol Head Neck Surg 2007; 15:74.

6.Brockstein, B, Vokes, EE. Concurrent chemoradiotherapy for head and neck cancer. Semin Oncol 2004; 31:786.7.Nair, MK, Sankaranarayanan, R, Padmanabhan, TK. Evaluation of the role of radiotherapy in the management of carcinoma of the buccal mucosa.

Cancer 1988; 61:1326.

8.Hong, WK, Bromer, RH, Amato, DA, et al. Patterns of relapse in locally advanced head and neck cancer patients who achieved complete remission

after combined modality therapy. Cancer 1985; 56:1242.


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Cisplatin + 5-FU

Reference:

1.Forastiere, AA, Metch, B, Schuller, DE, et al. Randomized comparison of cisplatin plus fluorouracil and carboplatin plus fluorouracil versus

methotrexate in advanced squamous-cell carcinoma of the head and neck: A Southwest Oncology Group study. J Clin Oncol 1992; 10:1245.

2.Jacobs, C,Lyman, G,Velez-Garcia, E, et al. A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination

for advanced squamous cell carcinoma of the head and neck. J Clin Oncol 1992; 10:257.

3.Rowland KM, Taylor SG, O'Donnell MR et al. Cisplatin and 5-FU infusion chemotherapy in advanced recurrent cancer of the head and neck: An

Eastern Cooperative Oncology Group pilot study. Cancer Treat Rep 1986; 70: 461-464.

口腔癌_treatment_protocol修訂_990901

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