Department of Otorhinolaryngology, Hospital Universitario Central de Asturias and Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.
Laryngoscope. 2011 Jul;121(7):1449-54. doi: 10.1002/lary.21787. Epub 2011 Jun 6.
The gold standard of treatment of cancer of the lateral wall of the oropharynx continues to be unclear, especially in advanced stages. In this study, we report our experience with surgical treatment of these cancers and describe the functional and oncological results of the procedures.
Retrospective review.
A total of 155 previously untreated patients with squamous cell carcinoma of the lateral wall of the oropharynx who underwent a surgical resection of the lesion at our department from January 1990 to January 2008 were included. Sixty-seven percent of these patients received postoperative radiotherapy. The records of these patients were reviewed to obtain measures such as local and regional control, disease-specific survival, and speech and swallowing function.
Six patients had a stage I disease, 15 had a stage II disease, 31 had a stage III disease, 86 had a stage IVA, and 17 had stage IVB disease. The overall recurrence rate was 60%, and the local recurrence rate was 40%. The 5-year overall survival and disease-specific survival rates were 33% and 43%, respectively. Five-year disease-specific survival rates by stage were as follows: 100%, 59%, 57%, 31%, and 33% for stages I to IVB, respectively. Multivariate analysis showed two parameters that were independent predictors of a reduced disease-specific survival: cervical lymph node metastases pN2-3 (P = .027) and primary tumor classified as pT3-4 (P = .029). In 122 patients, a tracheotomy was performed, and it couldn't be sealed in 23% of them. Oral alimentation was successfully recovered in 93% of the patients.
Surgical treatment of cancer of the lateral wall of the oropharynx provides acceptable oncological and functional results, especially in early and moderately advanced stages (stages I-III). In advanced stages (stage IV), we obtained good functional preservation rates but poor oncological outcomes. Consequently, these groups of patients could be considered for another treatment modality, such as radiochemotherapy.
癌症外侧壁口咽的治疗金标准仍不明确，尤其是在晚期。在本研究中，我们报告了对这些癌症进行手术治疗的经验，并描述了手术的功能和肿瘤学结果。
回顾性研究。
我们科室从 1990 年 1 月至 2008 年 1 月共收治了 155 例未经治疗的外侧壁口咽鳞癌患者，对病变进行了手术切除。其中 67%的患者接受了术后放疗。对这些患者的记录进行了回顾，以获得局部和区域控制、疾病特异性生存率以及言语和吞咽功能等指标。
6 例患者为 I 期疾病，15 例为 II 期疾病，31 例为 III 期疾病，86 例为 IVA 期疾病，17 例为 IVB 期疾病。总的复发率为 60%，局部复发率为 40%。5 年总生存率和疾病特异性生存率分别为 33%和 43%。按分期的 5 年疾病特异性生存率如下：I 期至 IVB 期分别为 100%、59%、57%、31%和 33%。多因素分析显示，两个参数是疾病特异性生存的独立预测因素：颈淋巴结转移 pN2-3（P=.027）和原发肿瘤分类为 pT3-4（P=.029）。在 122 例患者中，行气管切开术，其中 23%的患者不能封管。93%的患者成功恢复经口进食。
癌症外侧壁口咽的手术治疗可提供可接受的肿瘤学和功能结果，尤其是在早期和中度晚期（I-III 期）。在晚期（IV 期），我们获得了良好的功能保留率，但肿瘤学结果不佳。因此，这些患者可考虑采用其他治疗方法，如放化疗。
