Department of Head and Neck Cancer, University Clinic of Radiotherapy and Oncology, Skopje, Macedonia.
Radiat Oncol. 2010 May 18;5:39. doi: 10.1186/1748-717X-5-39.
Concurrent platinum-based radiochemotherapy has been recommended as a standard of care in patients with locally advanced squamous cell head and neck carcinomas. Unfortunately, there is a lack of level one evidence on best treatment approach for advanced hypopharyngeal cancer. This report aims to summarize the results of our study on concurrent radiochemotherapy in patients with advanced hypopharyngeal cancer.
A retrospective analysis of 41 patients with stage III-IV hypopharyngeal cancer was performed. All patients were treated with three dimensional conformal radiotherapy and received 70 Gy in 35 fractions (2 Gy per fraction, 5 fractions per week). In dependence of the period when radiotherapy was realized, two different treatment techniques were used. Concurrent chemotherapy consisted of cisplatin 30 mg/m2 given on a weekly basis.
The median age was 52 years (range 29-70). Stage IV disease was recognized in 73.2% of the patients. Complete response rates at the primary site and at the metastatic neck lymph nodes were 68.3% and 36.6%, respectively. A complete composite response was present in 27 patients (65.9%). Median follow-up was 13 months (range 7-36). Distant metastases as initial failure occurred in 7 patients (46.7%). The 2-year local relapse-free survival and regional relapse-free survival rates were 55.2% and 75.8%, respectively. The 2-year locoregional relapse-free survival rate was 51.3%. The 2-year disease-free survival and overall survival rates were 29.3% and 32.8%, respectively. Confluent mucositis was developed in 46.3% of patients. Leucopenia grade 1 was the most frequent hematological toxicity. The median weight loss at the end of treatment was 12% (range 5-21). The worst grade of late toxicity was most commonly pronounced in the skin and in the subcutaneous tissue.
Based on unsatisfactory results in our study we suggest that the use of sequential radiochemotherapy or chemotherapy given concomitantly with altered fractionation radiotherapy with the implementation of intensity-modulated radiotherapy as radiotherapy technique could represent treatment approaches able to improve outcome in patients with advanced hypopharyngeal cancer.
同步铂类放化疗已被推荐为局部晚期头颈部鳞状细胞癌患者的标准治疗方法。不幸的是，对于晚期下咽癌的最佳治疗方法，缺乏一级证据。本报告旨在总结我们对晚期下咽癌同步放化疗的研究结果。
对 41 例 III-IV 期下咽癌患者进行回顾性分析。所有患者均接受三维适形放疗，70 Gy 分 35 次（每次 2 Gy，每周 5 次）。根据放疗实施的时期，采用了两种不同的治疗技术。同期化疗采用顺铂 30 mg/m2 每周给药。
中位年龄为 52 岁（范围 29-70 岁）。73.2%的患者为 IV 期疾病。原发灶和转移性颈部淋巴结的完全缓解率分别为 68.3%和 36.6%。27 例患者（65.9%）完全复合缓解。中位随访时间为 13 个月（范围 7-36）。7 例（46.7%）患者以远处转移为首发失败。2 年局部无复发生存率和区域无复发生存率分别为 55.2%和 75.8%。2 年局部区域无复发生存率为 51.3%。2 年无病生存率和总生存率分别为 29.3%和 32.8%。46.3%的患者出现融合性粘膜炎。最常见的血液学毒性是白细胞减少症 1 级。治疗结束时的中位体重减轻为 12%（范围 5-21）。最严重的晚期毒性通常发生在皮肤和皮下组织。
基于我们研究中不满意的结果，我们建议使用序贯放化疗或与改变分割放疗同时给予化疗，并采用调强放疗作为放疗技术，这可能是提高晚期下咽癌患者治疗效果的方法。
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