The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press4210.17650/1818-8338-2013-1-48-54LECTIONЛЕКЦИЯRECURRENT ORAL AND OROPHARYNGEAL CANCER: CLINICAL PICTURE, DIAGNOSIS, AND TREATMENTРЕЦИДИВЫ РАКА СЛИЗИСТОЙ ОБОЛОЧКИ ПОЛОСТИ РТА И РОТОГЛОТКИ: КЛИНИКА, ДИАГНОСТИКА, ЛЕЧЕНИЕZaderenkoI. A.ЗадеренкоИ. А.
Russian Federation

Department of Oral Surgery and Surgical Dentistry

Кафедра челюстно-лицевой хирургии и хирургической стоматологии

igorakis@list.ruAliyevaS. B.АлиеваС. Б.
Russian Federation
DrobyshevA. Yu.ДробышевА. Ю.
Russian Federation

Department of Oral Surgery and Surgical Dentistry

Кафедра челюстно-лицевой хирургии и хирургической стоматологии

AzizyanR. I.АзизянР. И.
Russian Federation
A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of RussiaГБОУ ВПО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава РоссииN.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical SciencesФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» РАМН150120137148541507201415072014Copyright ©; 2013, Zaderenko I.A., Aliyeva S.B., Drobyshev A.Y., Azizyan R.I.Copyright ©; 2013, Задеренко И.А., Алиева С.Б., Дробышев А.Ю., Азизян Р.И.2013Zaderenko I.A., Aliyeva S.B., Drobyshev A.Y., Azizyan R.I.Задеренко И.А., Алиева С.Б., Дробышев А.Ю., Азизян Р.И.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/42

Malignant oral tumors account for 6 % in the total cancer incidence. The rate of recurrent tumors ranges from 25 to 50 %. About 80 % of patients with failed treatment are to undergo radiation, chemoradiation, or drug therapy. After retreatment, severe complications occur in more than half of the patients even to death (2 %). Some progress has been made in the treatment of recurrent tumors due to the current possibilities of surgical treatment. Surgical reintervention can be made and satisfactory treatment results obtained in a number of patients even if they develop recurrent tumor after a previous saving operation.

Злокачественные новообразования органов полости рта составляют 6 % в общей структуре онкологических заболеваний. Частота рецидивирования опухолей колеблется от 25 до 50 %. Около 80 % больных с неудачами лечения подлежат лучевой, химиолучевой или лекарственной терапии. Более чем у половины больных после повторного лечения возникают тяжелые осложнения вплоть до гибели (2 %). Определенный прогресс в лечении рецидивных опухолей достигнут благодаря использованию современных возможностей хирургического метода лечения. Даже в случае развития рецидива опухоли после ранее проведенной спасительной операции у ряда больных удается повторно выполнить хирургическое вмешательство и получить удовлетворительные результаты лечения.

squamous cell carcinoma of the mouthoropharyngeal cancerrecurrencesaving operationsprognostic factorsплоскоклеточный рак слизистой оболочки полости рта, рак ротоглоткирецидивспасительные операциифакторы прогноза1. Пачес А.И. Опухоли головы и шеи. М.: Медицина, 2000.Пачес А.И. Опухоли головы и шеи. М.: Медицина, 2000.2. Матякин Е.Г., Уваров А.А., Матяки н Г.Г., Парамонов В.А. Особенности хирургических вмешательств у больных раком полости рта и ротоглотки после радикального курса лучевой терапии. Мед радиол 1991;36(4):33–6.Матякин Е.Г., Уваров А.А., Матяки н Г.Г., Парамонов В.А. Особенности хирургических вмешательств у больных раком полости рта и ротоглотки после радикального курса лучевой терапии. Мед радиол 1991;36(4):33–6.3. Кропотов М.А., Соболевский В.А., Азизян Р.И. и др. Органосохраняющие и реконструктивные операции на нижней челюсти в комбинированном лечении рака слизистой оболочки полостиКропотов М.А., Соболевский В.А., Азизян Р.И. и др. Органосохраняющие и реконструктивные операции на нижней челюсти в комбинированном лечении рака слизистой оболочки полостирта: Учебное пособие. М., 2007. С. 4–15.4. Adelstein D.J., Lavertu P., Saxton J.P. et al. Mature results of a phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy along in respectable stage III and IVAdelstein D.J., Lavertu P., Saxton J.P. et al. Mature results of a phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy along in respectable stage III and IVsquamous cell carcinoma of the head and neck. Сancer 2000;88(4):876–83.5. Fu K.K., Pojak T.F., Trotti A. et al. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000;48(1):7–16.Fu K.K., Pojak T.F., Trotti A. et al. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000;48(1):7–16.6. Kagawa K., Yamaguchi H., Kizaki H. et al. Clinical significance of salvage surgery for recurrent pharyngeal or oral cancer after definitive radiation therapy. J Clin Oncol 2010;28(15 Suppl):e16018.Kagawa K., Yamaguchi H., Kizaki H. et al. Clinical significance of salvage surgery for recurrent pharyngeal or oral cancer after definitive radiation therapy. J Clin Oncol 2010;28(15 Suppl):e16018.7. Adelstein D.J. Squamous cell head and neck cancer. Humana Press Int., 2005.Adelstein D.J. Squamous cell head and neck cancer. Humana Press Int., 2005.8. Goodwin W.J.Jr. Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means? Laryngoscope 2000;110(3 Pt 2 Suppl 93):1–18.Goodwin W.J.Jr. Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means? Laryngoscope 2000;110(3 Pt 2 Suppl 93):1–18.9. Abgral R., Querellou S., Potard G. et al. Does 18F-FDG PET/CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up? J Nucl Med 2009;50(1):24–9.Abgral R., Querellou S., Potard G. et al. Does 18F-FDG PET/CT improve the detection of posttreatment recurrence of head and neck squamous cell carcinoma in patients negative for disease on clinical follow-up? J Nucl Med 2009;50(1):24–9.10. Lee J.K., Tyan Y.S., Huang W.S. Comparison of thallium-201 SPET and CT/MRI in the detection of residual/recurrent squamous cell carcinoma of the oral cavity. Eur J Nucl Med Mol ImagingLee J.K., Tyan Y.S., Huang W.S. Comparison of thallium-201 SPET and CT/MRI in the detection of residual/recurrent squamous cell carcinoma of the oral cavity. Eur J Nucl Med Mol Imaging2004;31(4):528–31.;31(4):528–31.11. Agra I.M., Carvalho A.L., Pinto C.A. et al. Biological markers and prognosis in recurrent cancer after salvage surgery. Arch Otolaryngol Head Neck Surg 2008;134(7):743–9.Agra I.M., Carvalho A.L., Pinto C.A. et al. Biological markers and prognosis in recurrent cancer after salvage surgery. Arch Otolaryngol Head Neck Surg 2008;134(7):743–9.12. Vermorken J.B. Medical treatment in head and neck cancer. Ann Oncol 2005;16(Suppl 2):ii258–ii264.Vermorken J.B. Medical treatment in head and neck cancer. Ann Oncol 2005;16(Suppl 2):ii258–ii264.13. Ng S.H., Yen T.C., Chang J.T. et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol 2006;24(27):4371–6.Ng S.H., Yen T.C., Chang J.T. et al. Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol 2006;24(27):4371–6.14. Lindberg R.D., Fletcher G.H. The role of irradiation in the management of head and neck cancer: analysis of results and causes of failure. Tumori 1978;64(3):313–25.Lindberg R.D., Fletcher G.H. The role of irradiation in the management of head and neck cancer: analysis of results and causes of failure. Tumori 1978;64(3):313–25.15. Stevens K.R.Jr, Britsch A., Moss W.T. High-dose reirradiation of head neck cancer with curative intent. Int J Radiat Oncol Biol Phys 1994;29(4):687–98.Stevens K.R.Jr, Britsch A., Moss W.T. High-dose reirradiation of head neck cancer with curative intent. Int J Radiat Oncol Biol Phys 1994;29(4):687–98.16. Wang C.C. To reirradiate or not to reirradiate? Int J Radiat Oncol Biol Phys 1994;29(4):913.Wang C.C. To reirradiate or not to reirradiate? Int J Radiat Oncol Biol Phys 1994;29(4):913.17. Tanvetyanon T., Padhya T., McCaffrey J. et al. Prognostic factors for survival after salvage reirradiation of head and neck cancer. J Clin Oncol 2009;27(12):1983–91.Tanvetyanon T., Padhya T., McCaffrey J. et al. Prognostic factors for survival after salvage reirradiation of head and neck cancer. J Clin Oncol 2009;27(12):1983–91.18. Vermorken J.B., Specenier P. Optimal treatment for recurrent/metastatic head and neck cancer. Ann Oncol 2010;21(Suppl 7):vii252–vii261.Vermorken J.B., Specenier P. Optimal treatment for recurrent/metastatic head and neck cancer. Ann Oncol 2010;21(Suppl 7):vii252–vii261.19. Choe K.S, Haraf D.J., Solanki A. et al. Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation. Cancer 2011;117(20):4671–8.Choe K.S, Haraf D.J., Solanki A. et al. Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation. Cancer 2011;117(20):4671–8.20. Arrannd J.P., Cvitkovic E., Recondo G. et al. Salvage chemotherapy in recurrent head neck cancer: the Institute Gustav Roués’ experience. Am J Otolaryngology 1993;14(5):301–6.Arrannd J.P., Cvitkovic E., Recondo G. et al. Salvage chemotherapy in recurrent head neck cancer: the Institute Gustav Roués’ experience. Am J Otolaryngology 1993;14(5):301–6.21. Forastiere A., Koch W., Trotti A., Sidransky D. Head and neck cancer. N Engl J Med 2001;345(26):1890–900.Forastiere A., Koch W., Trotti A., Sidransky D. Head and neck cancer. N Engl J Med 2001;345(26):1890–900.22. Lee S.C., Shores C.G., Weissler M.C. Salvage surgery after failed primary concomitant chemoradiation. Curr Opin Otolaryngol Head Neck Surg 2008;16(2):135–40.Lee S.C., Shores C.G., Weissler M.C. Salvage surgery after failed primary concomitant chemoradiation. Curr Opin Otolaryngol Head Neck Surg 2008;16(2):135–40.23. Koo B.S, Lim Y.C., Lee J.S., Choi E.C. Recurrence and salvage treatment of squamous cell carcinoma of the oral cavity. Oral Oncol 2006;42(8):789–94.Koo B.S, Lim Y.C., Lee J.S., Choi E.C. Recurrence and salvage treatment of squamous cell carcinoma of the oral cavity. Oral Oncol 2006;42(8):789–94.24. Gilbert H., Kagan A.R. Recurrence patterns in squamous cell carcinoma of the oral cavity, pharynx, and larynx. J Surg Oncol 1974;6(5):357–80.Gilbert H., Kagan A.R. Recurrence patterns in squamous cell carcinoma of the oral cavity, pharynx, and larynx. J Surg Oncol 1974;6(5):357–80.25. Agra I.M., Carvalho A.L., Ulbrich F.S. et al. Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer. Head Neck 2006;28(2):107–13.Agra I.M., Carvalho A.L., Ulbrich F.S. et al. Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer. Head Neck 2006;28(2):107–13.26. Kostrzewa J.P., Lancaster W.P., Iseli T.A. et al. Оutcomes of salvage surgery with free flap reconstruction for recurrent oral and oropharyngeal cancer. Laryngoscope 2010;120(2):267–72.Kostrzewa J.P., Lancaster W.P., Iseli T.A. et al. Оutcomes of salvage surgery with free flap reconstruction for recurrent oral and oropharyngeal cancer. Laryngoscope 2010;120(2):267–72.27. Magrin J., Kowalski L.P., Sabóia M., Sabóia R.P. Major glossectomy: end results of 106 cases. Eur J Cancer B Oral Oncol 1996;32B(6):407–12.Magrin J., Kowalski L.P., Sabóia M., Sabóia R.P. Major glossectomy: end results of 106 cases. Eur J Cancer B Oral Oncol 1996;32B(6):407–12.28. Yuen A.P., Wei W.I., Wong S.H., Ng R.W. Local recurrence of carcinoma of the tongue after glossectomy: patient prognosis. Ear Nose Throat J 1998;77(3):181–4.Yuen A.P., Wei W.I., Wong S.H., Ng R.W. Local recurrence of carcinoma of the tongue after glossectomy: patient prognosis. Ear Nose Throat J 1998;77(3):181–4.29. Agra I.M., Filho J.G., Martins E.P., Kowalski L.P. Second salvage surgery for rerecurrent oral cavity and oropharynx carcinoma. Head Neck 2010;32(8):997–1002.Agra I.M., Filho J.G., Martins E.P., Kowalski L.P. Second salvage surgery for rerecurrent oral cavity and oropharynx carcinoma. Head Neck 2010;32(8):997–1002.30. Федотенко С.П., Жарков О.А. Послеоперационные осложнения и выживаемость у больных раком полости рта и ротоглотк и, оперированных по поводу остаточной опухоли или рецидива после лучевой терапии. Опухоли головы и шеи 2011;(1):31–7.Федотенко С.П., Жарков О.А. Послеоперационные осложнения и выживаемость у больных раком полости рта и ротоглотк и, оперированных по поводу остаточной опухоли или рецидива после лучевой терапии. Опухоли головы и шеи 2011;(1):31–7.31. Liu S.A., Wong Y.K., Lin J.C. et al. Impact of recurrence interval on survival of oral cavity squamous cell carcinoma patients after local relapse. Otolaryngol Head Neck Surg 2007;136(1):112–8.Liu S.A., Wong Y.K., Lin J.C. et al. Impact of recurrence interval on survival of oral cavity squamous cell carcinoma patients after local relapse. Otolaryngol Head Neck Surg 2007;136(1):112–8.32. Mücke T., Wagenpfeil S., Kesting M.R. et al. Recurrence interval affects survival after local relapse of oral cancer. Oral Oncol 2009;45(8):687–91.Mücke T., Wagenpfeil S., Kesting M.R. et al. Recurrence interval affects survival after local relapse of oral cancer. Oral Oncol 2009;45(8):687–91.33. Nguyen T.V., Yueh B. Weight loss predicts mortality after recurrent oral cavity and oropharyngeal carcinomas. Cancer 2002;95(3):553–62.Nguyen T.V., Yueh B. Weight loss predicts mortality after recurrent oral cavity and oropharyngeal carcinomas. Cancer 2002;95(3):553–62.34. Davidson J., Keane T., Brown D. et al. Surgical salvage after radiotherapy for advanced laryngopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 1997;123(4):420–4.Davidson J., Keane T., Brown D. et al. Surgical salvage after radiotherapy for advanced laryngopharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 1997;123(4):420–4.35. Patel R.S., Clark J.R., Dirven R. et al. Prognostic factors in the surgical treatment of patients with oral carcinoma. ANZ J Surg 2009;79(1–2):19–22.Patel R.S., Clark J.R., Dirven R. et al. Prognostic factors in the surgical treatment of patients with oral carcinoma. ANZ J Surg 2009;79(1–2):19–22.36. Girod D.A., McCulloch T.M., Tsue T.T., Weymuller E.A. Jr. Risk factors for complications in cleanontaminated head and neck surgical procedures. Head Neck 1995;17(1):7–13.Girod D.A., McCulloch T.M., Tsue T.T., Weymuller E.A. Jr. Risk factors for complications in cleanontaminated head and neck surgical procedures. Head Neck 1995;17(1):7–13.37. Sassler A.M., Esclamado R.M., Wolf G.T. Surgery after organ-preservation: analysis of wound complications. Arch Otolaryngol Head Neck Surg 1995;121(2):162–5.Sassler A.M., Esclamado R.M., Wolf G.T. Surgery after organ-preservation: analysis of wound complications. Arch Otolaryngol Head Neck Surg 1995;121(2):162–5.