Rengan Ramesh, Pfister David G, Lee Nancy Y, Kraus Dennis H, Shah Jatin P, Shaha Ashok R, Ben-Porat Leah S, Zelefsky Michael J
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
Am J Clin Oncol. 2008 Oct;31(5):465-9. doi: 10.1097/COC.0b013e31816a6208.
To examine the long-term neck failure outcome in patients with advanced head and neck cancer treated on larynx/organ preservation protocols at Memorial Sloan-Kettering Cancer Center.
Two hundred thirteen patients were enrolled from 1983 through 1995 on larynx/organ preservation protocols receiving induction chemotherapy followed by radiotherapy alone or with concomitant chemotherapy. Eighty-six patients with node-positive disease received definitive chemoradiotherapy at Memorial Sloan-Kettering Cancer Center. A median dose of 70 Gy was delivered. The median follow-up of the surviving patients was 9 years.
Sixty-five patients with node-positive disease achieved a clinical complete response and were observed after chemoradiation without immediate neck dissection. The crude rate of subsequent neck failure among those patients according to initial nodal classification was: N1 14% (3 of 21), N2: 15% (6 of 40), N3: 0% (0 of 4). The median overall survival of these patients was: N1: 12.2 years; N2: 6.5 years; N3: 0.8 years. Patients who experienced a complete response to induction chemotherapy in the neck had improved overall survival (53% vs. 29%; P = 0.005) and a lower incidence of neck failure (10% vs. 24%; P = 0.14) when compared with those patients who had less than a complete response.
Our data suggests that in patients with advanced neck disease who have a clinical complete response in the neck to chemoradiation long-term neck control is 85% or greater without neck dissection. Whether functional imaging or treatment response to induction chemotherapy would provide better discrimination of the 10% to 15% who may experience neck relapse is an important question for future research initiatives.
研究在纪念斯隆凯特琳癌症中心接受喉/器官保留方案治疗的晚期头颈癌患者的长期颈部失败结局。
1983年至1995年，213例患者纳入喉/器官保留方案，接受诱导化疗，随后单独放疗或同步化疗。86例淋巴结阳性疾病患者在纪念斯隆凯特琳癌症中心接受了根治性放化疗。中位剂量为70 Gy。存活患者的中位随访时间为9年。
65例淋巴结阳性疾病患者实现临床完全缓解，放化疗后观察，未立即行颈部清扫术。根据初始淋巴结分类，这些患者随后颈部失败的粗发生率为：N1为14%（21例中的3例），N2为15%（40例中的6例），N3为0%（4例中的0例）。这些患者的中位总生存期为：N1为12.2年；N2为6.5年；N3为0.8年。与诱导化疗颈部反应不完全的患者相比，颈部对诱导化疗有完全反应的患者总生存期改善（53%对29%；P = 0.005），颈部失败发生率较低（10%对24%；P = 0.14）。
我们的数据表明，对于颈部疾病晚期且颈部对放化疗有临床完全反应的患者，不进行颈部清扫术的长期颈部控制率为85%或更高。功能成像或诱导化疗的治疗反应是否能更好地区分可能发生颈部复发的10%至15%的患者，是未来研究计划的一个重要问题。
