頭頸部癌の集学治療

MULTI-DISCIPLINARY TREATMENT FOR CANCER OF THE HEAD AND NECK

　頭頸部癌治療の目的は，発病前と同じく精神的にも身体的にも充実した生活をつづけさせることである。症例によつては腫瘍切除や数回の照射で済むものもあるが，周囲との調和を破つて腫瘍が進展していたり悪液質に陥つた症例も少なくない。そこで個々の症例に応じた併用療法が必要で，栄養状態の改善と広い意味の免疫的配慮や心療も含めて，手術・放射線・局所化学療法などをうまく組みあわせる。すなわち腫瘍を制御し，しかも治療障害が少なく，さらに社会復帰させながら再発は猶予をおかないで処置するわけである。要は複雑微妙に変動する癌と生体と治療の三者の関連を端的に示しているのが腫瘍増殖局所であるから，臨床像の違いと経過の診断に徹し，無理押ししない操作術式の体系化（集学治療）が求められている。そこで，併用療法の変遷と治療配量を検討すると，今後の頭頸部癌治療の方向を示唆する点があるので，ここに報告し諸賢のご批判をいただきたい。

　A review was made on 411 cases of head and neck cancer treated since 1974 with special reference to the therapeutic dosis of irradiation. In cancer of the paranasal sinuses and the nasal cavity, the irradiation dosis has been significantly decreasing by combining therapy consists of "reduction operation". Two modalities of irradiation, 800 rads and zero, were shown, and the cases received less than 400 rads have been increasing. While in cancer of the larynx, the pharynx and the oral cavity, most of the patients received a dose of less than 2000 rads combining with debridement, and a favorable result was achieved.

　A large majority of the recurrent tumor, "rT1", was successfully controlled ambulatorily.

　The immunological skin reactions to the immunopotentiators were observed. The group received a small dosis of irradiation including recurrent cases showed the remarkable improvement in the skin reaction.

　"Sustagen", an entrophic, was fairly effective for the patients especially for the aged who had lost weight. Some improvements in serum protein and other findings in hematology have been reported following the administration of Sustagen, and the patients kept the good nutritional and furthermore mental condition.

　The duration of hospitalization was greatly shortened to 6-10 days in the operated cases, 5-6 days in the unoperated.

　The short-term hospitalization and the long-term followup with a close observation on the general condition and the local findings of the patient would be an ideal approach for the treatment of head and neck cancer. These strategy can be applicable to the aged, too.

　An important factor in treatment for head and neck cancer is that the therapy should be coordinated and planned in a totalistic strategy involving reduction operation, irradiation, chemotherapy, immunotherapy and mental therapy.