:

6 7
3

HPV
&


BV



DNA 2 3

20% ( )

30
1/3

,

Rosenmuller.

87%

, V, V

orner

60%

41%

37%

30%

29%

16%

14%

10%

10%

8%

 WHO
1:

(25%)

HPV

2:

( 12%)

EBV

3:

(63%)

EBV
,
,

CT ,
,

RI


PET

(

)

EBV

gA ( anti viral capsid antigen)

IgG ( anti early antigen)

DCC antibody
dependent cellular toxicity

TNM AJCC
1-
2- /

T2a
2b

3 /
4 , /

, ,

1 < 6

2 - <
6
3 > 6 ( 3a)
( 3b)
M0
1


: T1N0M0

: T2N0M0
(
)
b: T1 2, 1,

( )


:
T1 2, 1 2, 0
3, 0 1 2, 0
V:
Va) T4, N0 1 2, 0
IVb) , 3, 0
IVc ) ,
, 1

3
4

2-3
1-3



6500-7000 cGy

H -
70-80%

10 10-40%
( 30%)

( BV)

BV

-
Fisch

,
,

.

.


.


(
)

2
3

(90%)

(60%)
(25%)
(10%)
(5%)

,

HPV 16 ( )

90%
o 10%

o
,

.
o


T1- 2 .

2- 2 4 .
3- 4 .
4-
,
,
,


1- 3

a) 3-6
b) 6
c)
6

3- > 6
0-
1-


( 50%)

,

.

.

,


.

60% 70%

20% 30%
20%


CT/MRI

US

CT ,

:
, ,

,
,

 &

72%

19%

18%

58%

25%

15%

45%

26%

7.5%

52%

29%

11%

PET Scan PET CT

( )

60


,
.




,

PET

+

:




( Cetuximab)

EGFR


& ( )

& V ()

()

0 1 (

)
2 3

Veterans
Affairs Study
(1991)

H&N
cancer

H&N cancer

Current trends in initial

management of oropharyngeal
cancer: the declining use of open
surgery.
Haigentz M Jr, et al.
Eur Arch Otorhinolaryngol
2009;266:1845-1855.

CCRT should be considered valid option for T4

laryngeal cancer. The presence of cartilage or bone
invasion should not be considered a contraindication
for enrollment in CCRT protocols

(level IA)
primary surgery
CCRT :

round up
salvage surgery

(level IIb, III)

, ..

Karatzanis AD, Psychogios G, Mantsopoulos K, Zenk J, Velegrakis GA,

Waldfahrer F, Iro H. Management of advanced carcinoma of the base
of tongue. J Surg Oncol 2012 Nov;106(6):713-8.

Late toxicity !!!

Machtay M, Moughan J, Trotti A, et al. Factors associated with severe late toxicity after concurrent
chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26:3582-3589.

/
,

Dworkin JP, Hill SL, Stachler RJ, Meleca RJ, Kewson D. Swallowing function outcomes following nonsurgical therapy
for advanced-stage laryngeal carcinoma. Dysphagia. 2006; 21:6674.

(Salvage Surgery):

Commando Operation:

(Combined mandibular oral cavity resection)

1& 2 ->
3& 4 ->

0 & 1 ->
2 & 3 ->

( )


(90%)

,

( 10%)

( Plummer Vinson Brown

Kelly Syndrome

30-50 , ,
, , )

60-75 %

,
,

(
Chevalier Jackson s sign)

, Fe, ,

, Ca,

CT, MRI

( 20%)


1- < 2

2 >2 <4
,

3 > 4
4

5 35%

1, 2
laser CO2
( )

( )

( + )

1 2

< 5

0

( 25%)