Khan A, Spiro J D, Dowsett R, Greenberg B R
Department of Medicine, University of Connecticut Health Center, Farmington 06030, USA.
Am J Clin Oncol. 1999 Aug;22(4):403-7. doi: 10.1097/00000421-199908000-00017.
Although there is no definite survival advantage to the use of sequential induction chemotherapy (CT) followed by radiotherapy (RT) in advanced resectable laryngeal cancer, this approach does succeed in preserving the larynx in many of these patients. The authors performed this study to analyze their results using a similar approach for patients with advanced resectable cancer located outside the larynx who would have required a total laryngectomy for oncologic or functional reasons. A retrospective study was performed at a single institution that included all patients with advanced resectable nonlaryngeal head and neck cancer treated with induction CT between January 1990 and August 1995. A total of 19 patients were included, with primary cancers located in the oropharynx in 14 patients, the hypopharynx in four, and the oral cavity and oropharynx in one. Eight patients had clinical stage III disease, and 11 patients had stage IV disease. Our treatment protocol consisted of two cycles of induction CT with cisplatin and 5-fluorouracil, followed by a third cycle of CT and subsequent RT in patients who achieved at least a clinical partial response (PR) after two courses of induction CT. Eighteen of 19 patients were evaluable for response. Overall, 13 patients (72%) had a major response (PR or CR) to induction CT at the primary site, and eight patients (57%) had a major response to chemotherapy in the neck. With a mean follow-up of 53 months (range, 24-71 months), the disease-specific survival was 57% for those patients with cancer of the oropharynx and oral cavity. In the subset of patients with hypopharynx cancer, 3 of 4 patients died of cancer despite achieving major response to induction CT. Organ preservation using sequential CT and RT for advanced resectable nonlaryngeal head and neck cancer is feasible, and the results in our experience with cancer of the oropharynx were similar to those reported for primary laryngeal cancer. Our limited experience using this protocol for cancer of the hypopharynx has been disappointing.
尽管在晚期可切除喉癌中使用序贯诱导化疗（CT）后放疗（RT）并没有明确的生存优势，但这种方法确实成功地使许多此类患者保留了喉部。作者进行这项研究，以分析他们对因肿瘤学或功能原因需要全喉切除术的晚期可切除喉外癌患者采用类似方法的结果。在单一机构进行了一项回顾性研究，纳入了1990年1月至1995年8月期间接受诱导CT治疗的所有晚期可切除非喉头颈癌患者。总共纳入了19例患者，其中14例原发癌位于口咽，4例位于下咽，1例位于口腔和口咽。8例患者为临床III期疾病，11例患者为IV期疾病。我们的治疗方案包括两个周期的顺铂和5-氟尿嘧啶诱导CT，然后对在两个疗程诱导CT后至少达到临床部分缓解（PR）的患者进行第三个周期的CT及随后的放疗。19例患者中有18例可评估反应。总体而言，13例患者（72%）在原发部位对诱导CT有主要反应（PR或CR），8例患者（57%）在颈部对化疗有主要反应。平均随访53个月（范围24 - 71个月），口咽和口腔癌患者的疾病特异性生存率为57%。在下咽癌患者亚组中，4例患者中有3例尽管对诱导CT有主要反应，但仍死于癌症。对于晚期可切除非喉头颈癌，采用序贯CT和RT进行器官保留是可行的，我们对口咽癌的经验结果与原发性喉癌报道的结果相似。我们使用该方案治疗下咽癌的经验有限，令人失望。
