Samant S, Kumar P, Wan J, Hanchett C, Vieira F, Murry T, Wong F S, Robbins K T
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee-Memphis, 956 Court Avenue, Memphis, TN 38163, USA.
Head Neck. 1999 Oct;21(7):595-601. doi: 10.1002/(sici)1097-0347(199910)21:7<595::aid-hed2>3.0.co;2-j.
Squamous cell carcinoma of the pyriform sinus is an unfavorable disease which frequently presents in advanced stages. Despite aggressive "standard treatment" involving debilitating surgery and postoperative radiation therapy treatments, the survival and functional outcome for pyriform sinus carcinoma remains poor. Hence, we reviewed our experience in the management of advanced pyriform sinus carcinoma using "organ preservation" chemoradiation therapy.
Twenty-five patients diagnosed with stage III/IV pyriform sinus squamous cell carcinoma treated with supradose, intra-arterial targeted cisplatin, and concomitant radiotherapy were analyzed for response rates, survival, pattern of failure, and function of the preserved organs. Our protocol consisted of weekly intra-arterial infusions of cisplatin at 150 mg/m(2) x 4 and concurrent radiation therapy at 1.8 Gy or 2.0 Gy/fraction to a planned total of 68-74 Gy to the primary site/overt nodal disease.
Nineteen (76%) of the 25 patients were diagnosed with stage IV disease, 17 of whom were first seen with bulky lymphadenopathy (ie, N2-N3 disease) while 10 had T4 lesions. Twenty-four of 25 patients were evaluable for response assessment. Complete response rates of 92% and 76% were achieved at the primary site and in lymph nodes, respectively. Hence, the overall complete response rate in the neck was 76% (16/21). At a median follow up interval of 42 months (range = 30-58 months), the projected 5-year overall and disease-specific survival using the Kaplan-Meier method are 23% and 50% respectively. No patient has developed recurrence at the primary site and only one patient relapsed regionally, which was surgically salvaged for an "above clavicle" disease control rate of 88% and an organ preservation rate of 88%. Almost 90% of the patients have achieved a satisfactory voice and 70% are able to swallow at 12 months postcompletion of therapy.
Our chemoradiation protocol is as effective as other treatment modalities for patients with advanced pyriform sinus carcinoma while maintaining organ preservation and function in the majority of the patients.
梨状窦鳞状细胞癌是一种预后不良的疾病，常处于晚期。尽管采用了包括致残性手术和术后放射治疗在内的积极“标准治疗”，梨状窦癌的生存率和功能预后仍然很差。因此，我们回顾了我们使用“器官保留”放化疗治疗晚期梨状窦癌的经验。
分析了25例诊断为III/IV期梨状窦鳞状细胞癌并接受超剂量动脉内靶向顺铂和同步放疗的患者的缓解率、生存率、失败模式和保留器官的功能。我们的方案包括每周动脉内输注顺铂，剂量为150mg/m²，共4次，同时进行放射治疗，每次分割剂量为1.8Gy或2.0Gy，计划对原发部位/明显的淋巴结疾病给予总量68 - 74Gy的照射。
25例患者中有19例（76%）被诊断为IV期疾病，其中17例初诊时伴有巨大淋巴结病（即N2 - N3期疾病），10例有T4病变。25例患者中有24例可进行缓解评估。原发部位和淋巴结的完全缓解率分别为92%和76%。因此，颈部的总体完全缓解率为76%（16/21）。在中位随访间隔42个月（范围 = 30 - 58个月）时，使用Kaplan - Meier方法预测的5年总生存率和疾病特异性生存率分别为23%和50%。没有患者在原发部位出现复发，只有1例患者出现局部复发，经手术挽救后，“锁骨上”疾病控制率为88%，器官保留率为88%。几乎90%的患者在治疗完成后12个月时声音恢复满意，70%的患者能够吞咽。
我们的放化疗方案对晚期梨状窦癌患者与其他治疗方式一样有效，同时在大多数患者中维持了器官保留和功能。
