Worden Francis P, Moyer Jeffrey, Lee Julia S, Taylor Jeremy M G, Urba Susan G, Eisbruch Avraham, Teknos Theodoros N, Chepeha Douglas B, Prince Mark E, Hogikyan Norman, Lassig Amy Anne D, Emerick Kevin, Mukherji Suresh, Hadjiski Lubomir, Tsien Christina I, Miller Tamara H, Wallace Nancy E, Mason Heidi L, Bradford Carol R, Wolf Gregory T
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, USA.
Laryngoscope. 2009 Aug;119(8):1510-7. doi: 10.1002/lary.20294.
OBJECTIVES/HYPOTHESIS: High rates of overall survival (OS) and laryngeal preservation were achieved in two sequential phase II clinical trials in patients with stage III/IV laryngeal squamous cell carcinoma (SCC). Patients were treated with chemoradiation after a >50% primary tumor response to one cycle of neoadjuvant chemotherapy (IC). We analyzed outcomes for T4 patients with cartilage invasion from both studies.
Retrospective.
Records from 36 patients with T4 SCC of the larynx with cartilage invasion alone (n = 16) or cartilage invasion and extralaryngeal spread (n = 20) were retrospectively reviewed. All were treated with one cycle of cisplatin (100 mg/m(2)) [or carboplatin (AUC 6)] and 5-fluorouracil (1,000 mg/m(2)/d for 5 days) (P+5FU). Those achieving >50% response at the primary tumor received chemoradiation (70 Gy; 35 fractions with concurrent cisplatin-100 mg/m(2) [carboplatin (AUC 6)] every 21 days for 3 cycles), followed by adjuvant P+5FU for complete histologic responders (CHR). Patients with <50% response after IC underwent total laryngectomy and postoperative radiation.
Twenty-nine of 36 patients (81%) had >50% response following IC. Of these, 27 received definitive chemoradiation, 23 (85%) obtained CHR, with 58% laryngeal preservation rate. The 3-year OS was 78%, and the disease-specific survival was 80% (median follow-up 69 months). Following chemoradiation, 8/11 (73%) patients with an intact larynx had >75% understandable speech, 6/36 (17%) were g-tube dependent and 6/36 (17%) were tracheostomy dependent.
Our results suggest that chemo-selection is a feasible organ preservation alternative to total laryngectomy for patients with T4 laryngeal SCC with cartilage invasion.
目的/假设：在两项针对 III/IV 期喉鳞状细胞癌（SCC）患者的序贯 II 期临床试验中，实现了较高的总生存率（OS）和喉保留率。患者在对一个周期的新辅助化疗（IC）产生>50%的原发肿瘤反应后接受放化疗。我们分析了两项研究中 T4 期伴有软骨侵犯患者的预后情况。
回顾性研究。
回顾性分析 36 例仅伴有软骨侵犯（n = 16）或伴有软骨侵犯及喉外扩散（n = 20）的 T4 期喉 SCC 患者的记录。所有患者均接受一个周期的顺铂（100 mg/m²）[或卡铂（AUC 6）]和 5-氟尿嘧啶（1000 mg/m²/天，共 5 天）（P + 5FU）治疗。那些原发肿瘤反应>50%的患者接受放化疗（70 Gy；35 次分割，同时每 21 天给予顺铂 100 mg/m²[卡铂（AUC 6）]，共 3 个周期），随后对组织学完全缓解者（CHR）给予辅助性 P + 5FU 治疗。IC 后反应<50%的患者接受全喉切除术及术后放疗。
36 例患者中有 29 例（81%）在 IC 后反应>50%。其中，27 例接受了确定性放化疗，23 例（85%）获得 CHR，喉保留率为 58%。3 年总生存率为 78%，疾病特异性生存率为 80%（中位随访 69 个月）。放化疗后，11 例喉完整的患者中有 8 例（73%）言语可懂度>75%，36 例中有 6 例（17%）依赖胃造瘘管，36 例中有 6 例（17%）依赖气管造口术。
我们的结果表明，对于伴有软骨侵犯的 T4 期喉 SCC 患者，化疗选择是一种可行且能替代全喉切除术的保留器官的方法。
