Allal A S, Dulguerov P, Bieri S, Lehmann W, Kurtz J M
Division of Radiation Oncology, University Hospital of Geneva, Switzerland.
Head Neck. 1999 May;21(3):217-22. doi: 10.1002/(sici)1097-0347(199905)21:3<217::aid-hed6>3.0.co;2-s.
Surgical management of advanced neck disease remains controversial when a conservative approach based on radiotherapy is retained for primary tumors. The objective of this study was to evaluate retrospectively treatment results in pharyngeal cancers presenting with N2-N3 neck disease, using neck dissection followed by radical locoregional radiotherapy (RT) and to compare these results with those obtained in patients treated by radical RT alone.
From August 1991 to November 1996, 41 patients with carcinomas of the oro- or hypopharynx were staged as T1-T3 N2-N3 M0 (American Joint Committee on Cancer [AJCC] stage IV). Twenty-four patients were treated with neck dissection followed by RT (group 1) and 17 patients with radical RT (group 2) using a progressively accelerated concomitant boost schedule. Chemotherapy was delivered to 6 patients in group 1 and 8 in group 2 partially concomitantly with RT.
Three-year actuarial locoregional control was 73% and 55% for groups 1 and 2, respectively (p = .52). The corresponding 3-year actuarial overall survival rates were 37% and 50% (p = .42). Severe postoperative complications were observed after neck dissection in four patients (16%). Acute toxicity during RT was similar in the two groups. Late toxicities were also similar, except for two patients in group 1 who developed severe laryngeal edema.
Neck dissection followed by radical RT to the primary tumor and neck represents a valid treatment option in this subset of patients, allowing good control of advanced neck disease, while at the same time conserving pharyngolaryngeal function. However, for patients who are at high risk of severe postoperative complications, radical RT can be considered a worthy alternative, particularly for oropharyngeal carcinomas.
对于原发性肿瘤采用基于放疗的保守治疗方法时，晚期颈部疾病的外科治疗仍存在争议。本研究的目的是回顾性评估采用颈部清扫术联合根治性局部区域放疗（RT）治疗出现N2 - N3颈部疾病的下咽癌的治疗结果，并将这些结果与仅接受根治性放疗的患者的结果进行比较。
从1991年8月至1996年11月，41例口咽或下咽癌患者被分期为T1 - T3 N2 - N3 M0（美国癌症联合委员会[AJCC]IV期）。24例患者接受颈部清扫术联合放疗（第1组），17例患者接受根治性放疗（第2组），采用逐步加速同步推量放疗方案。第1组6例患者和第2组8例患者在放疗的同时部分接受了化疗。
第1组和第2组的3年精算局部区域控制率分别为73%和55%（p = 0.52）。相应的3年精算总生存率分别为37%和50%（p = 0.42）。4例患者（16%）在颈部清扫术后出现严重的术后并发症。两组放疗期间的急性毒性相似。晚期毒性也相似，除了第1组有2例患者出现严重的喉水肿。
对原发肿瘤和颈部进行颈部清扫术联合根治性放疗是这类患者的一种有效治疗选择，能很好地控制晚期颈部疾病，同时保留咽喉功能。然而，对于术后出现严重并发症风险较高的患者，根治性放疗可被视为一种有价值的替代方案，特别是对于口咽癌患者。
