头颈部癌初始同步放化疗失败后挽救性手术的有效性
The effectiveness of salvage surgery after the failure of primary concomitant chemoradiation in head and neck cancer.
作者信息
Richey Luke M, Shores Carol G, George Jonathan, Lee Steve, Couch Marion J, Sutton David K, Weissler Mark C
机构信息
General Clinical Research Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599-7070, USA.
出版信息
Otolaryngol Head Neck Surg. 2007 Jan;136(1):98-103. doi: 10.1016/j.otohns.2006.06.1267.
OBJECTIVE
To determine survival outcomes and locoregional control rates in patients with locoregional head and neck squamous cell cancer (HNSCC) who failed primary concomitant chemoradiation (CRT) intended for cure and underwent attempted surgical salvage.
STUDY DESIGN AND SETTING
Design was a nonrandomized retrospective cohort study. Of 204 patients with HNSCC who received primary concomitant chemoradiation intended for cure between 1995 and 2004, 38 recurred and underwent attempted salvage surgery at a tertiary care academic center.
RESULTS
Among the 38 patients undergoing surgical salvage, 12- and 24-month overall survival rates were 60 percent and 27 percent. Locoregional control at 24 months was 42 percent. Lower survival was seen with initial N3 disease (P = 0.0115). Overall surgical morbidity was 24 percent.
CONCLUSION/SIGNIFICANCE: The results of salvage surgery after failed chemoradiation for HNSCC are poor. Those with N3 disease fare least well. Patients should be well informed about the realistic chances of cure and potential morbidity of surgery.
目的
确定局部区域晚期头颈鳞状细胞癌（HNSCC）患者在接受旨在治愈的初始同步放化疗（CRT）失败后接受挽救性手术的生存结果和局部区域控制率。
研究设计与背景
设计为非随机回顾性队列研究。在1995年至2004年间接受旨在治愈的初始同步放化疗的204例HNSCC患者中，38例复发并在一家三级医疗学术中心接受了挽救性手术尝试。
结果
在接受挽救性手术的38例患者中，12个月和24个月的总生存率分别为60%和27%。24个月时的局部区域控制率为42%。初始为N3期疾病的患者生存率较低（P = 0.0115）。总体手术并发症发生率为24%。
结论/意义：HNSCC同步放化疗失败后挽救性手术的结果较差。N3期疾病患者预后最差。应让患者充分了解治愈的实际可能性和手术的潜在并发症。
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