Kessler Peter, Grabenbauer Gerhard, Leher Anna, Bloch-Birkholz Alexandra, Vairaktaris Elephtherios, Neukam Friedrich Wilhelm, Sauer Rolf
Klinik und Poliklinik für Mund-, Kiefer-, Gesichtschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.
Strahlenther Onkol. 2007 Apr;183(4):184-9. doi: 10.1007/s00066-007-1469-8.
In recent years, different concepts for the treatment of oral squamous cell carcinomas (OSCC) have been developed; these include preoperative simultaneous neoadjuvant radiochemotherapy and one-stage surgery with tumor ablation and reconstruction. When considering long-term survival, there is substantial evidence that multimodality treatment based on a neoadjuvant radiochemotherapy is superior to adjuvant therapy concepts based on a surgical approach with postoperative irradiation. The aim of this study was to discuss the 5-year survival rate in a neoadjuvant and an adjuvant combination treatment in patients with primary OSCC.
This nonrandomized longitudinal study prospectively evaluates the long-term tumor-free survival in 128 patients with oral cancer. Two groups consisting of 74 neoadjuvantly and 54 primarily surgically treated patients were formed. 99 patients suffered from stage III and IV disease according to the UICC criteria. Long-term survival was estimated according to the Kaplan-Meier assumption.
The neoadjuvant treatment increases the prospect of a long-term tumor-free survival. According to Kaplan-Meier assumption the estimation for a 5-year tumor-free survival in OSCC in category T1 is 83.1% in neoadjuvant, and 70.1% in adjuvant treatment, in T2 79.6% and 57.7%, in T3 68.2% and 33.2%, in T4 51.4% and 30.5%, respectively. Significance (p<0.05) could be proven for T1 (p=0.002), T2 (p=0.028), and T4 (p<0.0001) tumors. The effectiveness of the preoperative radiochemotherapy was demonstrated in the pathohistological result of tumor-free resection specimens in 28 patients of the neoadjuvant treatment group (37.8%). On the other hand, four patients died during the preoperative combination therapy. 64.8% of the patients in the adjuvant and 71.6% in the neoadjuvant treatment group survived the observation period.
Neoadjuvant therapy is highly effective and results in a better 5-year survival rate than adjuvant treatment. All patients with primary OSCC should be selected for such a treatment. Future therapy concepts should combine the effectiveness of a systemic treatment with the safety of a limited surgical resection of the tumor site to preserve as much function as possible.
近年来，已开发出不同的口腔鳞状细胞癌（OSCC）治疗理念；这些理念包括术前同步新辅助放化疗以及肿瘤切除与重建的一期手术。在考虑长期生存时，有大量证据表明基于新辅助放化疗的多模式治疗优于基于手术联合术后放疗的辅助治疗理念。本研究的目的是探讨原发性OSCC患者新辅助和辅助联合治疗的5年生存率。
这项非随机纵向研究前瞻性评估了128例口腔癌患者的长期无瘤生存率。形成了两组，分别为74例接受新辅助治疗和54例接受初次手术治疗的患者。根据国际抗癌联盟（UICC）标准，99例患者患有III期和IV期疾病。根据Kaplan-Meier假设估计长期生存率。
新辅助治疗增加了长期无瘤生存的前景。根据Kaplan-Meier假设，T1期OSCC患者新辅助治疗5年无瘤生存率估计为83.1%，辅助治疗为70.1%；T2期分别为79.6%和57.7%；T3期分别为68.2%和33.2%；T4期分别为51.4%和30.5%。T1（p = 0.002）、T2（p = 0.028）和T4（p < 0.0001）肿瘤可证明具有显著性差异（p < 0.05）。新辅助治疗组28例患者（37.8%）的无瘤切除标本病理组织学结果证明了术前放化疗的有效性。另一方面，4例患者在术前联合治疗期间死亡。辅助治疗组64.8%的患者和新辅助治疗组71.6%的患者存活至观察期结束。
新辅助治疗高度有效，5年生存率优于辅助治疗。所有原发性OSCC患者都应选择这种治疗。未来的治疗理念应将全身治疗的有效性与肿瘤部位有限手术切除的安全性相结合，以尽可能保留更多功能。
