Лучевая терапия плоскоклеточного рака кожи: современные стандарты и дальнейшие перспективы

Плоскоклеточный рак кожи составляет 20 % всех злокачественных немеланомных новообразований кожи, являющихся одними из самых распространенных онкологических заболеваний в мире. противоопухолевое лечение, как правило, достаточно эффективно. частота излечения достигает 90 %, а общая частота локальных рецидивов – 25 %. Основным методом лечения первичных злокачественных новообразований кожи является хирургическое вмешательство. К ключевым факторам риска локорегионарного рецидива относятся локализация (область головы и шеи), размер (диаметр >2 см), глубина инвазии (>4 мм), дифференцировка опухоли, периневральное поражение, нарушение иммунного статуса пациента (иммуносупрессия), выраженная сопутствующая патология и предыдущее лечение. при лечении больных с запущенными формами плоскоклеточного рака кожи показатели 1-, 2- и 3-летней общей выживаемости составляют 50–80, 30–35 и 15–16 % соответственно. лучевая терапия относится к радикальным вариантам лечения данной патологии и обеспечивает 5-летние показатели выживаемости на уровне 90 %, а также хорошие косметические результаты в 80 % случаев. существуют 3 основных направления применения этого вида лечения плоскоклеточного рака кожи: самостоятельное по радикальной программе, адъювантное в комбинации с оперативным вмешательством и паллиативная лучевая терапия. чаще всего лучевая терапия используется в рамках адъювантного послеоперационного лечения и изначально не рассматривается в качестве самостоятельного консервативного лечения пациентов с плоскоклеточным раком кожи моложе 45 лет и при резектабельности опухоли, особенно высокого риска. самостоятельная лучевая терапия проводится при неоперабельности пациентов, нерезектабельности опухоли, функционально или косметически неудовлетворительных потенциальных результатах хирургического вмешательства, а также при отказе от операции. паллиативная лучевая терапия является доступным, хорошо зарекомендовавшим себя методом борьбы с тягостной симптоматикой и нередко обеспечивает длительный локальный контроль над опухолью.

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