Sarini Jérôme, Bocciolini Corso, Fournier Charles, Penel Nicolas, Kara Ahmed, Van Jean Ton, Lefebvre Jean-Louis
Département de cancérologie cervico-faciale, Centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59020 Lille Cedex.
Bull Cancer. 2002 Apr;89(4):411-7.
Surgery followed by irradiation is considered to be the standard treatment but require frequently a total laryngectomy. Chemotherapy followed by irradiation is available in larynx and hypopharynx squamous cell carcinoma (SCC) treatment. Are results obtained in daily induction chemotherapy usefulness identical to results obtained in larynx preservation studies?
We conducted a retrospective study on patients treated at centre Oscar-Lambret, Lille, from 1986 to 1995, by chemotherapy followed by definitive radiotherapy or by surgery and radiotherapy for laryngeal or hypopharyngeal cancer treatment. All patients were naive of previous head and neck SCC and a surgical treatment, requiring total laryngectomy, should be proposed with curative intent. Induction chemotherapy associated cisplatin (100 mg/m2) on day 1 and 5-fluorouracil (5FU)(1,000 mg/m2) on days 1-4 or 1-5. Irradiation was performed for responders (complete or partial > 50%). If case of non-responder, patients underwent surgical treatment followed by irradiation. We compared results obtained with patients enrolled in clinical trial and with patients whom benefited from this protocol out of trial.
Hundred-eight patients were evaluable for purposes of this study. Fifty-two patients were included in clinical trial (group 1) while 56 patients (group 2) were not. There was no statistical difference as regard neither to sex nor to node (palpable or not palpable) and metastasis status between the groups. We found a higher frequency of laryngeal tumour in group 2 (31 vs 17; p =.03). We observed more stage III and less stage IV in group 1. For chemotherapy-related toxic reactions, the exclusive statistical difference observed was haematological toxicity grade III and IV after the second cycle (0 pt in group 1 vs 8 pts in group 2; p =.02). After initial treatment, complete response was achieved without statistical difference between the groups (88.2% vs 78%; p =.27). A surgical procedure was performed in 46 cases without difference according to the reference group and functional larynx preservation was 55.8% (29/52) in group 1 and 53.6% (30/56) in group 2. Whatever the group, causes of death were similarly distributed. Cancer was the first cause of death in both groups. The overall survival of the population (108 patients) was 81.5% at one year, 49.6% at 3 years and 35.3% at 5 years with a median survival of 3 years. There was no statistical difference between both groups. Some parameters influenced the overall survival like T (p =.04), response to chemotherapy (p=.006), extra capsular spread (p = 0.03) and response after completion treatment.
Induction chemotherapy is available for larynx preservation but cannot be considered as a standard treatment. Nevertheless, results should be reproduced in daily practice with experimented teams as found with non included patient's results. The long-term side effects of such protocols should be evaluated. Recent publication, on increase postoperative infection after chemotherapy, should be evaluated in clinical trial. If confirmed, cost effectiveness of such complication must be integrated in larynx preservation protocols. Larynx preservation remains an interesting point of view for patients but stay an optional procedure and not a reference.
手术加放疗被认为是标准治疗方法，但通常需要进行全喉切除术。化疗加放疗可用于喉癌和下咽鳞状细胞癌（SCC）的治疗。每日诱导化疗所取得的结果与喉保留研究中获得的结果是否相同？
我们对1986年至1995年在里尔奥斯卡 - 兰布雷中心接受治疗的患者进行了一项回顾性研究，这些患者接受化疗后再进行根治性放疗，或接受手术及放疗以治疗喉癌或下咽癌。所有患者既往均未患过头颈SCC且未接受过手术治疗，若需进行全喉切除术，则应以治愈为目的进行。诱导化疗在第1天使用顺铂（100 mg/m²），在第1 - 4天或第1 - 5天使用氟尿嘧啶（5FU）（1,000 mg/m²）。对有反应者（完全缓解或部分缓解>50%）进行放疗。若为无反应者，则患者接受手术治疗后再进行放疗。我们将本研究中纳入临床试验的患者与未参与试验但受益于该方案的患者所取得的结果进行了比较。
本研究共纳入108例可评估患者。52例患者纳入临床试验（第1组），56例患者（第2组）未纳入。两组在性别、淋巴结（可触及或不可触及）及转移状态方面均无统计学差异。我们发现第2组喉肿瘤的发生率更高（31例对17例；p = 0.03）。我们观察到第1组III期患者更多，IV期患者更少。对于化疗相关的毒性反应，观察到的唯一统计学差异是第二个周期后III级和IV级血液学毒性（第1组0例对第2组8例；p = 0.02）。初始治疗后，两组间完全缓解率无统计学差异（88.2%对78%；p = 0.27）。46例患者接受了手术治疗，与参照组相比无差异，第1组功能性喉保留率为55.8%（29/52），第2组为53.6%（30/56）。无论在哪一组，死亡原因分布相似。两组中癌症均是首要死亡原因。总体人群（108例患者）的1年总生存率为81.5%，3年为49.6%，5年为35.3%，中位生存期为3年。两组间无统计学差异。一些参数影响总生存率，如T（p = 0.04）、对化疗的反应（p = 0.006）、包膜外扩散（p = 0.03）及完成治疗后的反应。
诱导化疗可用于喉保留，但不能被视为标准治疗方法。然而，应如非纳入患者的结果所示，由经验丰富的团队在日常实践中重现这些结果。应评估此类方案的长期副作用。近期关于化疗后术后感染增加的出版物应在临床试验中进行评估。若得到证实，此类并发症的成本效益必须纳入喉保留方案。喉保留对患者而言仍是一个有意义的观点，但仍是一种可选择的手术方式，而非标准治疗方法。
