Department of Otolaryngology Head and Neck Surgery, The Freeman Hospital, Newcastle upon Tyne, UK.
Eur Arch Otorhinolaryngol. 2011 Mar;268(3):437-42. doi: 10.1007/s00405-010-1362-4. Epub 2010 Aug 27.
National guidelines state that early-stage oropharyngeal carcinoma can be treated by either primary surgery or radiotherapy. There is a paucity of evidence comparing surgery versus non-surgical therapy within the same population. With the shift in head and neck cancer treatment towards primary chemoradiation, the aim of this observational cohort study was to help define whether surgery still has a role for early-stage oropharyngeal disease, using a national prospective audit of all new head and neck cancers recruited between 1999 and 2001 in Scotland. Patients with T1-2 N0 M0 tumours were identified. Patients were divided into those treated surgically (±adjuvant radiotherapy) or non-surgically. Five-year outcome data were calculated. Forty-two patients were treated surgically (13 received adjuvant radiotherapy) and 32 patients treated non-surgically. Disease-specific 5-year survival was 69 and 60%, respectively (p = 0.22). Locoregional failure occurred in seven of the surgical group and five of the non-surgical group. The success of chemoradiotherapy and the evidence for its use as adjuvant therapy may dissuade clinicians from considering surgical intervention. This study demonstrates the outcomes of surgical and non-surgical therapy within the same population. Where clear margins can be achieved, and in the absence of negative prognostic neck pathology, surgery remains a good option; allowing radiotherapy to be preserved for locoregional failures or second primary tumours. Although there are limitations to this study, it does demonstrate the benefit of prospective population data collection.
国家指南指出，早期口咽癌可以通过手术或放疗进行治疗。在同一人群中，比较手术与非手术治疗的证据很少。随着头颈部癌症治疗向原发放化疗转移，本观察性队列研究旨在通过对 1999 年至 2001 年在苏格兰招募的所有新的头颈部癌症患者进行全国性前瞻性审计，帮助确定手术是否仍对头颈部早期疾病具有作用。识别出 T1-2N0M0 肿瘤的患者。将患者分为手术治疗（±辅助放疗）或非手术治疗。计算五年的预后数据。42 例患者接受手术治疗（13 例接受辅助放疗），32 例患者接受非手术治疗。疾病特异性 5 年生存率分别为 69%和 60%（p=0.22）。手术组中有 7 例和非手术组中有 5 例发生局部区域失败。放化疗的成功以及作为辅助治疗的证据可能会使临床医生不再考虑手术干预。本研究展示了同一人群中手术和非手术治疗的结果。在可以获得明确切缘且无阴性预后颈部病理的情况下，手术仍然是一个不错的选择；为局部区域失败或第二原发肿瘤保留放疗。尽管这项研究存在局限性，但它确实证明了前瞻性人群数据收集的益处。
