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Опухоли головы и шеи

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Современная стратегия диагностики и лечения плоскоклеточного рака кожи

https://doi.org/10.17650/2222-1468-2021-11-1-51-72

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Аннотация

Плоскоклеточный рак кожи (ПКРК) - второй по распространенности рак кожи после базальноклеточного. Противоопухолевое лечение, как правило, достаточно эффективно: частота излечения достигает 90 %. Особенностью первичного ПКРК является вариабельность темпов роста, а также склонность к поражению регионарных лимфатических узлов (от 1 % при высокодифференцированных опухолях до 10 % при низкой степени дифференцировки, размере >3 см и/или глубине инвазии >4 мм). В случае развития ПКРК в области послеожогового рубца частота регионарного метастазирования достигает 10-30 %. Существует также относительно небольшая вероятность отдаленного метастазирования с общей летальностью 2-3 %. При ПКРК головы и шеи возможно как гематогенное, так и периневральное распространение в ЦНС. Общая частота локальных рецидивов составляет 25 %. К основным факторам риска локорегионарного рецидива относятся локализация (в области головы и шеи), размер (>2 см), глубина инвазии (>4 мм), дифференцировка опухоли, периневральное поражение, иммунный статус пациента и предыдущее лечение. Опухоли, возникшие на участках, которые не подвергались воздействию солнечной радиации, и опухоли, возникшие в зоне предшествующего облучения, термического повреждения, рубцевания или хронического язвенного поражения, более склонны к рецидивированию и метастазированию. Низкодифференцированный и анапластический ПКРК метастазирует чаще, чем высокодифференцированный. Срединно расположенные опухоли в области маски лица и губы наиболее склонны к невральной инвазии. При определении тактики лечения требуется мультидисциплинарный подход, определяемый с обязательным участием всех специалистов по противоопухолевому лечению.

Об авторах

А. П. Поляков
Московский научно-исследовательский онкологический институт им. П.А. Герцена — филиал ФГБУ Национальный медицинский исследовательский центр радиологии Минздрава России
Россия

Андрей Павлович Поляков

125284 Москва, 2-й Боткинский пр-д, 3



А. Р. Геворков
Московский научно-исследовательский онкологический институт им. П.А. Герцена — филиал ФГБУ Национальный медицинский исследовательский центр радиологии Минздрава России
Россия

125284 Москва, 2-й Боткинский пр-д, 3



А. А. Степанова
Медицинский институт непрерывного образования ФГБОУ ВО Московский государственный университет пищевых производств
Россия

125080 Москва, Волоколамское шоссе, 11



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Для цитирования:


Поляков А.П., Геворков А.Р., Степанова А.А. Современная стратегия диагностики и лечения плоскоклеточного рака кожи. Опухоли головы и шеи. 2021;11(1):51-72. https://doi.org/10.17650/2222-1468-2021-11-1-51-72

For citation:


Polyakov A.P., Gevorkov A.R., Stepanova A.A. Current strategy of squamous cell carcinoma diagnosis and treatment. Head and Neck Tumors (HNT). 2021;11(1):51-72. (In Russ.) https://doi.org/10.17650/2222-1468-2021-11-1-51-72

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