Pfister D G, Strong E, Harrison L, Haines I E, Pfister D A, Sessions R, Spiro R, Shah J, Gerold F, McLure T
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
J Clin Oncol. 1991 May;9(5):850-9. doi: 10.1200/JCO.1991.9.5.850.
Forty patients with advanced, resectable squamous cell carcinoma of the larynx, oropharynx, or hypopharynx whose surgery would have required total laryngectomy (TL), were treated with one to three cycles of cisplatin-based chemotherapy before local therapy with the goal of larynx preservation. Clinical complete responses (CRs) or partial responses (PRs) to chemotherapy were seen in 26 of 40 patients (65%). Three patients with primary-site disease unresponsive to chemotherapy underwent resection of the primary lesion and neck dissection followed by radiation therapy (RT). Thirty-seven patients were referred after chemotherapy for RT +/- neck dissection. Thirty-one of 40 patient (78%) were rendered disease-free (no evidence of disease [NED]). With a median follow-up of 49 months (range, 31 to 76), the overall actuarial survival rate for the group was 58% at 2 years and 33% at 5 years. The failure-free survival rate was 42% and 33% at 2 and 5 years, respectively. Seven patients refused recommended TL throughout their course. This may have adversely affected survival results. A greater proportion of patients who achieved a CR or PR to chemotherapy remained disease-free compared with those who achieved less than a PR (P less than .001). Sixteen patients relapsed, 10 with locoregional disease. Six patients underwent TL, either for initial induction failure or at relapse, for an actual larynx-preservation rate of 34 of 40 patients (85%). If the seven patients who refused TL are included, the anticipated preservation rate is 27 of 40 patients (68%). Larynx preservation with combined chemotherapy and radiation is feasible and effective in patients with advanced, resectable squamous cell carcinoma of the head and neck (SCHN). This treatment approach requires a motivated patient, careful patient monitoring, and close interdisciplinary cooperation among oncologists.
40例患有晚期、可切除的喉、口咽或下咽鳞状细胞癌且手术原本需要行全喉切除术（TL）的患者，在局部治疗前接受了1至3个周期的以顺铂为基础的化疗，目的是保留喉部。40例患者中有26例（65%）对化疗出现临床完全缓解（CR）或部分缓解（PR）。3例对化疗无反应的原发部位疾病患者接受了原发灶切除及颈部清扫术，随后进行放射治疗（RT）。37例患者在化疗后接受RT +/- 颈部清扫术。40例患者中有31例（78%）达到无病状态（无疾病证据[NED]）。中位随访时间为49个月（范围31至76个月），该组患者2年时的总精算生存率为58%，5年时为33%。无失败生存率在2年和5年时分别为42%和33%。7例患者在整个病程中拒绝推荐的TL。这可能对生存结果产生了不利影响。与未达到PR的患者相比，化疗达到CR或PR的患者中无病状态的比例更高（P <.001）。16例患者复发，10例为局部区域疾病复发。6例患者因初始诱导失败或复发而接受了TL，实际喉部保留率为40例患者中的34例（85%）。如果包括7例拒绝TL的患者，预期保留率为40例患者中的27例（68%）。联合化疗和放疗保留喉部在晚期、可切除的头颈部鳞状细胞癌（SCHN）患者中是可行且有效的。这种治疗方法需要患者积极配合、仔细监测患者，以及肿瘤学家之间密切的多学科合作。
