Holsinger F Christopher, Funk Etai, Roberts Dianna B, Diaz Eduardo M
Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 441, Houston, Texas 77030-4009, USA.
Head Neck. 2006 Sep;28(9):779-84. doi: 10.1002/hed.20415.
Total laryngectomy is the standard of care for surgical salvage of radiation failure in laryngeal cancer. However, the role of conservation laryngeal surgery in this setting remains unclear. The objective was to compare the efficacy of conservation versus total laryngectomy for salvage of radiation failure in patients who initially presented with T1 or T2 squamous cancer of the larynx.
A 21-year retrospective analysis of patients who received surgery at a single comprehensive cancer center after definitive radiation therapy is reported. At recurrence, the patients were reevaluated and then underwent a total laryngectomy or, if possible, a conservation laryngeal procedure. The charts of 105 patients who failed radiation treatment for primary laryngeal cancer and who subsequently underwent surgical salvage were reviewed for this study. Eighty-nine were male (84.8%). The mean age was 60.3 years. The median follow-up time after surgery was 69.4 months. Most patients with recurrence after radiotherapy required total laryngectomy (69.5%; 73/105). Conservation laryngeal surgery was performed for 32 patients (31.5%). Concomitant neck dissections were performed on 45 patients (45.5%).
In 14 patients, local or regional recurrence developed after salvage surgery: 9 patients after total laryngectomy (12.3%; 9/73), and 5 patients (15.6%; 5/32) after conservation laryngeal surgery. This difference was not statistically significant, nor was there a difference in disease-free interval for the two procedures (p = .634, by log-rank test). Distant metastasis developed in 13 patients. Most developed in the setting of local and/or regional recurrence, but distant metastasis occurred as the only site of failure in 6 of the patients who had undergone total laryngectomy but in 1 of the conservation surgery patients treated for a supraglottic laryngeal cancer. The overall mortality for patients who underwent total laryngectomy was also higher: 73.74% (54/73) versus 59.4% (19/32) for patients who underwent a conservation approach (p = .011 by log-rank test).
Although conservation laryngeal surgery was possible in a few patients with local failure after radiotherapy, conservation laryngeal surgery is an oncologically sound alternative to total laryngectomy for these patients.
全喉切除术是挽救喉癌放疗失败的标准治疗方法。然而，在这种情况下保留喉手术的作用仍不明确。目的是比较保留喉手术与全喉切除术对最初表现为T1或T2喉鳞状癌患者放疗失败后的挽救效果。
报告了对在单一综合癌症中心接受根治性放疗后接受手术的患者进行的21年回顾性分析。复发时，对患者进行重新评估，然后进行全喉切除术，或在可能的情况下进行保留喉手术。本研究回顾了105例原发性喉癌放疗失败并随后接受手术挽救的患者的病历。89例为男性（84.8%）。平均年龄为60.3岁。术后中位随访时间为69.4个月。大多数放疗后复发的患者需要进行全喉切除术（69.5%；73/105）。32例患者（31.5%）进行了保留喉手术。45例患者（45.5%）同时进行了颈部淋巴结清扫术。
14例患者在挽救手术后出现局部或区域复发：9例在全喉切除术后（12.3%；9/73），5例在保留喉手术后（15.6%；5/32）。这种差异无统计学意义，两种手术的无病生存期也无差异（对数秩检验，p = 0.634）。13例患者发生远处转移。大多数发生在局部和/或区域复发的情况下，但远处转移是全喉切除术后6例患者唯一的失败部位，而在1例接受声门上喉癌保留手术的患者中也是唯一的失败部位。接受全喉切除术患者的总体死亡率也更高：73.74%（54/73），而接受保留手术的患者为59.4%（19/32）（对数秩检验，p = 0.011）。
尽管少数放疗后局部失败的患者可以进行保留喉手术，但对于这些患者，保留喉手术是全喉切除术在肿瘤学上合理的替代方法。
