Young VyVy N, Mangus Brannon D, Bumpous Jeffrey M
Division of Otolaryngology, Department of Surgery, University of Louisville, Louisville, Kentucky, USA.
Laryngoscope. 2008 Sep;118(9):1561-8. doi: 10.1097/MLG.0b013e31817c1321.
OBJECTIVES/HYPOTHESIS: To determine the rate of salvage laryngectomy after failure of radiation or chemoradiation over 10-year course, identify factors associated with increased risk of treatment failure, assess survival after salvage laryngectomy.
Retrospective review.
Twenty patients who underwent salvage total laryngectomy were studied. Overall interval to recurrence (ITR) was 9.9 months, overall postsalvage-laryngectomy survival (PSL-OAS) 25 months, and interval to death (PSL-ITD) 15.8 months. Mortality was 85%.
Four patients failed chemoradiation and 16 failed radiation alone. Based on treatment, there was no difference in ITR (12.8 vs. 8.8 months, P = .27) or PSL-OAS (27.5 vs. 24.4 months, P = .86). PSL-ITD was significantly higher after chemoradiation (27.5 vs. 12.2 months, P = .02). Advanced T-stage patients were significantly younger than early-stage (53 vs. 64 years, P = .02), but had no significant difference in ITR (12.7 vs. 6.8 months, P = .08), PSL-OAS (20.1 vs. 33.6 months, P = .35), or PSL-ITD (12 vs. 21.6 months, P = .1). Analysis by site and differentiation showed no significant differences. Heavy alcohol use/alcoholism was reported in >50%. Rate of fistulization was 20%. Three patients currently survive, with average postsalvage-laryngectomy disease-free survival (PSL-DFS) 77 months.
Salvage laryngectomy is an uncommon procedure (7% over 10-year period). There is no difference in survival after salvage laryngectomy for radiation or chemoradiation failure. Patients failing chemoradiation have longer PSL-ITD than those failing radiation alone. Patients with T3-4 tumors tend to be younger. T-stage of tumor does not affect rate of salvage procedure. Fistulae formed in 20%. Neither location nor differentiation affects survival. Surgical salvage after primary conservative treatment is associated with an approximately 2-year survival.
目的/假设：确定放疗或放化疗失败后挽救性喉切除术在10年病程中的发生率，识别与治疗失败风险增加相关的因素，评估挽救性喉切除术后的生存率。
回顾性研究。
对20例行挽救性全喉切除术的患者进行研究。至复发的总间隔时间（ITR）为9.9个月，挽救性喉切除术后总生存时间（PSL - OAS）为25个月，至死亡的间隔时间（PSL - ITD）为15.8个月。死亡率为85%。
4例患者放化疗失败，16例仅放疗失败。基于治疗方式，ITR（12.8对8.8个月，P = 0.27）或PSL - OAS（27.5对24.4个月，P = 0.86）无差异。放化疗后PSL - ITD显著更长（27.5对12.2个月，P = 0.02）。晚期T分期患者显著比早期患者年轻（53对64岁，P = 0.02），但在ITR（12.7对6.8个月，P = 0.08）、PSL - OAS（20.1对33.6个月，P = 0.35）或PSL - ITD（12对21.6个月，P = 0.1）方面无显著差异。按部位和分化程度分析无显著差异。超过50%的患者报告有重度饮酒/酗酒情况。瘘管形成率为20%。3例患者目前存活，挽救性喉切除术后平均无病生存时间（PSL - DFS）为77个月。
挽救性喉切除术是一种不常见的手术（10年期间发生率为7%）。放疗或放化疗失败后挽救性喉切除术后的生存率无差异。放化疗失败的患者PSL - ITD比仅放疗失败的患者更长。T3 - 4期肿瘤患者往往更年轻。肿瘤的T分期不影响挽救手术的发生率。20%的患者形成了瘘管。部位和分化程度均不影响生存率。初次保守治疗后的手术挽救与大约2年的生存期相关。
