Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.
Head Neck. 2011 Dec;33(12):1727-34. doi: 10.1002/hed.21657. Epub 2011 Jan 18.
The purpose of this study was to elucidate factors associated with pharyngoesophageal strictures after treatment for head and neck squamous cell carcinoma (SCC).
We conducted a retrospective review of patients receiving cisplatin and 5-fluorouracil chemotherapy combined with concurrent hyperfractionated radiation therapy for oropharyngeal squamous cell carcinoma.
Strictures developed in 13 of 67 patients (19%). Strictures were associated with tumor location (tonsil vs base of tongue; p = .03), neck dissection after completion of therapy (p = .03), and the duration of treatment-induced mucositis (weeks with mucositis grade ≥2; National Cancer Institute (NCI) Common Toxicity Criteria; p < .001). Age, sex, race, tumor stage, nodal stage, American Joint Committee on Cancer (AJCC) stage, human papillomavirus (HPV) status, smoking, radiation dose, maximum severity of mucositis, amifostine use, and pretreatment swallow dysfunction were not significantly associated with stricture. In multivariate analysis, only duration of mucositis, after controlling for age, sex, and tumor location, remained highly significant (p < .01).
The duration of treatment-related mucositis is an independent risk factor for stricture formation in patients with oropharyngeal SCC treated with concurrent chemotherapy and radiation therapy.
本研究旨在阐明头颈部鳞状细胞癌（SCC）治疗后咽食管狭窄的相关因素。
我们对接受顺铂和 5-氟尿嘧啶化疗联合同期超分割放疗的口咽鳞状细胞癌患者进行了回顾性研究。
67 例患者中有 13 例（19%）发生狭窄。狭窄与肿瘤位置（扁桃体与舌根；p=0.03）、治疗后颈部清扫术（p=0.03）和治疗相关黏膜炎持续时间（美国国立癌症研究所（NCI）常见毒性标准，黏膜炎≥2 级的周数；p<0.001）相关。年龄、性别、种族、肿瘤分期、淋巴结分期、美国癌症联合委员会（AJCC）分期、人乳头瘤病毒（HPV）状态、吸烟、放疗剂量、黏膜炎最严重程度、氨磷汀的使用以及治疗前吞咽功能障碍与狭窄均无显著相关性。多因素分析显示，仅黏膜炎持续时间与年龄、性别和肿瘤位置相关，且具有显著相关性（p<0.01）。
在接受同期化疗和放疗的口咽 SCC 患者中，治疗相关黏膜炎的持续时间是狭窄形成的独立危险因素。
