New Advances in Comprehensive Treatment of Head and Neck Tumors

Head and neck tumors include neck tumors, ENT tumors and oral and maxillofacial tumors. Neck tumors belong to general surgery in general hospitals, and the more common ones are thyroid tumors; ENT tumors commonly include laryngeal cancer, paranasal sinus cancer, etc. Oral and maxillofacial tumors are commonly various oral cancers, such as tongue cancer, gingival cancer, buccal cancer, etc. Therefore, head and neck tumors have the largest number of primary sites and types of pathologies in the whole body. Therefore, tumors occurring in the head and neck region are the most common tumors in the whole body in terms of the number of primary sites and types of pathology. At the same time, the vital organs in the head and neck are more concentrated, the anatomical relationship is complicated, and the treatment methods are different. According to the information provided by international epidemiological research institutions, head and neck tumors are the 5th most common tumors worldwide, accounting for less than 10% of all malignant tumors in Europe and the United States, while they are more common in China, accounting for about 19.9%-30.2%. The annual incidence rate of head and neck tumors in China in recent years is 15.22/100,000, accounting for 4.45% of systemic malignant tumors (2.51/100,000 in men and 1.92/100,000 in women). The improvement of surgical techniques of Maning, Department of Medical Oncology, Henan Provincial People’s Hospital, has significantly improved the efficacy of some types of early-stage patients, but 70%-80% of the patients are already in locally advanced or advanced stages when they visit the clinic, and more than 50% of the newly-diagnosed patients can not be cured and will recur locally or metastasize to the distal region, and 10% of the newly-diagnosed patients have distal metastasis. For this subset of patients, medical therapy becomes an important component of curative treatment. Clinical oncology guidelines have clarified the priority of chemotherapy over radiotherapy to avoid the local vascular destruction caused by radiotherapy that reduces the effectiveness of chemotherapy. Chemotherapy is the standard of care in the treatment of recurrent and/or metastatic cancers today, especially with the advent of targeted agents, which have further increased the efficacy of chemotherapy. Ebituxan (cetuximab) combined with chemoradiotherapy in the treatment of patients with advanced head and neck tumors in primary treatment can improve their overall survival from an average of 29.3 months to 49.0 months, does not increase the incidence of oral mucositis of radiotherapy, and increases the rate of surgical laryngeal preservation, which improves the patient’s quality of life, and Ebituxan + chemoradiotherapy provides a new choice for patients with high-risk locally advanced head and neck tumors who are not able to tolerate chemotherapy and radiotherapy at the same time. The choice. In platinum-failed recurrent/metastatic squamous head and neck cancer, the use of Ebitux alone or in combination with platinum-based chemotherapy in platinum-failed patients significantly improves tumor resistance and increases the efficacy of treatment, with an increase in the efficiency of at least 10% and an increase in the average overall survival from 3.4 months to 6.1 months. For advanced drug-resistant patients, a nearly 3-month improvement in survival is already a significant benefit. Recombinant human p53 adenovirus product (recombinant adenovirus-p53 rAd-p53) utilizes adenovirus as a vector to introduce the wild-type P53 gene into cancer cells to induce apoptosis and promote lysis and death of cancer cells. Basic and clinical studies at home and abroad have shown that rAd-p53 not only increases the sensitivity of tumor cells to radiotherapy, but also has no cross-toxicity and significantly reduces the side effects of radiotherapy, which has the effect of increasing the efficacy and reducing the toxicity of clinical efficacy. Local (intratumoral) administration at a dose of 1×1012VP/dose for the treatment of nasopharyngeal carcinoma and squamous carcinoma of the head and neck, regardless of single agent or combined with radiotherapy/chemotherapy, can significantly achieve the purpose of tumor shrinkage, and it has become the first domestic and international approved indication for the use of rAd-p53. The treatment of any kind of malignant tumor is a comprehensive treatment process integrating surgery, chemotherapy, biotargeted therapy, radiotherapy, local minimally invasive therapy, etc. Any kind of single treatment mode hinders the progress of clinical oncology, so how to flexibly and effectively choose the combination of different treatment modalities in order to maximize the benefit of patients has become the reference standard for evaluating the level of treatment. Oncology Department of Provincial Medical Department selects synchronous and sequential radiotherapy according to the patients’ physical condition and disease changes; anthracycline, doxorubicin/paclitaxel, gemcitabine, pemetrexed, platinum and fluorouracil are added into the combination chemotherapy; direct injection of P53 adenovirus into the tumor body locally can make the tumor body shrink significantly; single or combined chemoradiation and gene therapy with targeted drugs can further increase the therapeutic efficacy, and commonly used targeted drugs include anti-epidermal growth factor (EGF) and anti-epidermal growth factor (EGRF) drugs, which are used to treat the tumor body. Commonly used targeted drugs include anti-epidermal growth factor receptor monoclonal antibody cetuximab, tyrosine kinase inhibitor Erasmus or Trocet, and anti-vascular epidermal growth factor receptor monoclonal antibody bevacizumab; through the combined application of perioperative treatment, postoperative local and systemic therapy and other integrated therapies, the overall survival of patients with primary head and neck tumors can reach nearly 50 months. Our department also has unique treatment methods for oral mucositis, a serious adverse reaction caused by radiotherapy for head and neck tumors, and has a long-term good cooperative relationship with surgery departments such as stomatology, orthopedics, otorhinolaryngology, general surgery, as well as radiology, radiation therapy, pathology, and so on, and we have comprehensive diagnosis and treatment resources that are not available in other specialties and general hospitals. Resources. As we all know, the treatment of malignant tumors is a multidisciplinary comprehensive treatment, and the means of comprehensive treatment is the technical advantage of our department, which can optimize the cost-benefit ratio of the patients, and achieve the lowest cost, the highest quality of life, and the longest survival period!