Arnold David J, Goodwin W Jerry, Weed Donald T, Civantos Francisco J
University of Miami School of Medicine, Miami, FL 33136, USA.
Semin Radiat Oncol. 2004 Apr;14(2):190-5. doi: 10.1053/j.semradonc.2004.03.001.
Despite advances in our ability to safely treat patients with recurrent cancer of the upper aerodigestive tract, outcomes for retreatment are generally poor and the first chance to cure these patients remains the best chance. Thorough knowledge of the outlook and options for patients with recurrent disease is also of significance in choosing therapy for patients with newly diagnosed disease. This is especially true for newly diagnosed patients making the choice between surgery and nonsurgical ("organ-sparing") options, who need to know the outlook for salvage surgery, should they recur after radiation with or without concomitant chemotherapy. Salvage surgery is generally the best option for previously irradiated patients who are faced with resectable, recurrent disease. Unfortunately, the results of surgical salvage are generally poor for patients with advanced stage recurrence and for those who recur after treatment of advanced disease. The site of initial and recurrent disease is important. Surgical salvage is most effective for patients with recurrent laryngeal cancer, least effective for recurrent cancer of the pharynx, and is intermediate for recurrence in the oral cavity. Patients choosing nonsurgical treatment for newly diagnosed cancer of the pharynx cannot rely on salvage surgery in the event of recurrence. Reirraditation for patients who have failed initial treatment that included radiation therapy has been used at a number of institutions with some success. Experience using reirradiation with or without concomitant chemotherapy continues to evolve. Palliative chemotherapy is an option for most patients, but response rates are generally poor and of short duration, after failure of initial treatment that includes radiation therapy. The best approach for many patients and families who face advanced recurrent disease is honest but compassionate communication and supportive care with the help of a hospice organization.
尽管我们在安全治疗上消化道复发性癌症患者的能力方面取得了进展，但再次治疗的结果通常较差，治愈这些患者的第一次机会仍然是最佳机会。全面了解复发性疾病患者的预后和选择对于为新诊断疾病患者选择治疗方法也具有重要意义。对于新诊断的患者在手术和非手术（“保留器官”）选择之间做出抉择时尤其如此，他们需要了解如果在放疗（无论是否联合化疗）后复发，挽救性手术的预后情况。挽救性手术通常是那些接受过放疗且面临可切除复发性疾病的患者的最佳选择。不幸的是，对于晚期复发患者以及那些在晚期疾病治疗后复发的患者，手术挽救的结果通常较差。初始疾病和复发性疾病的部位很重要。手术挽救对复发性喉癌患者最有效，对复发性咽癌患者最无效，对口腔复发患者则介于两者之间。选择非手术治疗新诊断的咽癌患者如果复发不能依赖挽救性手术。对包括放疗在内的初始治疗失败的患者进行再次放疗已在许多机构使用并取得了一些成功。使用再次放疗联合或不联合化疗的经验仍在不断发展。姑息化疗是大多数患者的一种选择，但在包括放疗在内的初始治疗失败后，缓解率通常较低且持续时间短。对于许多面临晚期复发性疾病的患者及其家属来说，最好的方法是在临终关怀组织的帮助下进行坦诚而富有同情心的沟通和支持性护理。
