Lindholm Paula, Valavaara Ritva, Aitasalo Kalle, Kulmala Jarmo, Laine Juhani, Elomaa Liisa, Sillanmäki Lauri, Minn Heikki, Grénman Reidar
Department of Oncology and Radiotherapy, University of Turku, Turku, Finland.
Radiother Oncol. 2006 Feb;78(2):146-51. doi: 10.1016/j.radonc.2005.11.002. Epub 2005 Nov 22.
To evaluate whether preoperative hyperfractionated accelerated radiotherapy (RT) combined with major radical surgery is feasible and successful in the treatment of advanced primary head and neck cancer.
Ninety four patients with histologically confirmed head and neck squamous cell cancer (HNSCC) in the oral cavity (41/96; 43%), supraglottis (14/96; 15%), glottis (5/96; 5%), oropharynx (16/96; 17%), nasal cavity/paranasal sinuses (8/96; 8%), nasopharynx (3/96; 3%), hypopharynx (7/96; 7%) and two (2%) with unknown primary tumour and large cervical lymph nodes entered into the study. 21/96 patients (22%) had stage II, 17/96 (18%) stage III and 58/96 patients (60%) stage IV disease. The patients received preoperative hyperfractionated RT 1.6 Gy twice a day, 5 days a week to a median tumour dose of 63 Gy with a planned break for 11 days (median) after the median dose of 37 Gy. Then, after a median of 27 days the patients underwent major radical surgery of the primary tumour and metastatic lymph nodes including reconstructions with pedicled or microvascular free flaps when indicated as a part of the scheduled therapy. 12/96 patients had only ipsilateral or bilateral neck dissections.
After a median follow-up time of 37.2 mos 77/96 (80.2%) patients had complete locoregional control. All but 2 patients had complete histological remission after surgery. 40/96 pts were alive without disease, two of them after salvage surgery. 32/96 patients had relapsed; 15 had locoregional and 13 distant relapses, 4 patients relapsed both locoregionally and distantly. Fifty patients have died; 29 with locoregional and/or distant relapse, eight patients died of second malignancy, and 19 had intercurrent diseases. Disease-specific and overall survival at 3 years was 67.7 and 51%, respectively. Acute grade three mucosal reactions were common, but transient and tolerable. Late grade 3-4 adverse effects were few.
Preoperative hyperfractionated accelerated RT can be successfully combined with major radical surgery in the treatment of HNSCC. The amount of serious late adverse effects was not increased.
评估术前超分割加速放疗（RT）联合根治性大手术治疗晚期原发性头颈癌是否可行且成功。
94例经组织学确诊的头颈鳞状细胞癌（HNSCC）患者纳入研究，其中口腔癌41例（41/96；43%）、声门上癌14例（14/96；15%）、声门癌5例（5/96；5%）、口咽癌16例（16/96；17%）、鼻腔/鼻窦癌8例（8/96；8%）、鼻咽癌3例（3/96；3%）、下咽癌7例（7/96；7%），另有2例（2%）原发肿瘤不明但有巨大颈部淋巴结。96例患者中，21例（22%）为Ⅱ期，17例（18%）为Ⅲ期，58例（60%）为Ⅳ期。患者接受术前超分割放疗，每日2次，每次1.6 Gy，每周5天，中位肿瘤剂量达63 Gy，在中位剂量37 Gy后计划休息11天（中位）。然后，中位27天后患者接受原发肿瘤及转移淋巴结的根治性大手术，必要时包括带蒂或游离微血管皮瓣重建，作为预定治疗的一部分。96例患者中有12例仅行同侧或双侧颈清扫术。
中位随访37.2个月后，96例患者中有77例（80.2%）实现局部区域完全控制。除2例患者外，所有患者术后均实现组织学完全缓解。96例患者中有40例无病存活，其中2例为挽救性手术后存活。96例患者中有32例复发；15例为局部区域复发，13例为远处复发，4例局部区域和远处均复发。50例患者死亡；29例因局部区域和/或远处复发死亡，8例死于第二原发恶性肿瘤，19例死于并发疾病。3年疾病特异性生存率和总生存率分别为67.7%和51%。急性3级黏膜反应常见，但为一过性且可耐受。晚期3 - 4级不良反应较少。
术前超分割加速放疗可成功联合根治性大手术治疗头颈鳞状细胞癌。严重晚期不良反应数量未增加。
Zotero 插件