Chopra Supriya, Gupta Tejpal, Agarwal Jai Prakash, Budrukkar Ashwini, Ghosh-Laskar Sarbani, Dinshaw Ketayun
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
Radiother Oncol. 2006 Oct;81(1):1-8. doi: 10.1016/j.radonc.2006.08.017. Epub 2006 Sep 12.
Recent times have witnessed significant improvements in outcome for head and neck squamous cell carcinomas. Nevertheless, the major pattern of failure continues to remain loco-regional. Isolated neck recurrence, although uncommon, occurs in 5-7% of patients after radical treatment. The options for this subgroup are somewhat limited and are often guided by empiricism rather than evidence. This review attempts to systematically analyze the therapeutic options for patients with isolated neck recurrence following radical treatment for the primary and draining cervical lymph nodes, with a special emphasis on re-irradiation. Salvage neck dissection offers the best chance of cure to patients with resectable neck recurrences. The perceived increased risk of complications of re-irradiation following previous curative dose irradiation has precluded optimal evaluation of its potential in this setting. Post-operative adjuvant re-irradiation should be based on histo-pathological findings of the salvage surgery. Re-irradiation with or without chemotherapy may be considered for unresectable neck recurrences. The role of chemotherapy continues to evolve and is presently not optimally defined. There is lack of high-quality evidence pertinent to salvage therapy leading to vast variations in practice. More patients with recurrent disease should be enrolled onto prospective clinical trials with relevant and meaningful endpoints.
近年来，头颈部鳞状细胞癌的治疗效果有了显著改善。然而，主要的失败模式仍然是局部区域复发。孤立性颈部复发虽然不常见，但在根治性治疗后的患者中发生率为5%-7%。该亚组患者的治疗选择有些有限，且往往受经验主义而非证据的指导。本综述试图系统分析原发性和引流性颈部淋巴结根治性治疗后孤立性颈部复发患者的治疗选择，特别强调再程放疗。挽救性颈清扫术为可切除颈部复发患者提供了最佳的治愈机会。在先前接受根治性剂量照射后，再程放疗并发症风险增加的观念阻碍了对其在这种情况下潜力的最佳评估。术后辅助再程放疗应基于挽救性手术的组织病理学结果。对于不可切除的颈部复发，可考虑进行再程放疗，联合或不联合化疗。化疗的作用仍在不断演变，目前尚未得到最佳定义。缺乏与挽救性治疗相关的高质量证据，导致实践中存在很大差异。更多复发疾病患者应纳入具有相关且有意义终点的前瞻性临床试验。
