Department of Radiation Oncology, University of Lubeck, Lubeck, Germany.
Strahlenther Onkol. 2011 Sep;187(9):541-7. doi: 10.1007/s00066-011-2262-2. Epub 2011 Aug 16.
The standard treatment for non-metastatic stage III/IV squamous cell carcinoma of the head and neck varies worldwide. This study compared the outcomes of radiochemotherapy alone to surgery followed by radio(chemo)therapy (radiotherapy plus/minus concurrent chemotherapy).
Data from 148 patients treated with radiochemotherapy alone were matched to 148 patients treated with surgery plus radio(chemo)therapy. Groups were matched 1:1 for nine potential prognostic factors including age, gender, performance status, tumor site, histologic grade, T category, N category, AJCC stage, and hemoglobin level before radiotherapy, and compared for locoregional control, metastases-free survival, and overall survival.
Locoregional control rates at 1, 2, and 3 years were 81%, 73%, and 67% after surgery plus radio(chemo)therapy and 81%, 74%, and 65% after radiochemotherapy alone (p = 0.89). Metastases-free survival rates were 86%, 80%, and 75% after surgery plus radio(chemotherapy) versus 87%, 80%, and 72% after radiochemotherapy alone (p = 0.57). Overall survival rates were 80%, 64%, and 63% after surgery plus radio(chemo)therapy versus 83%, 68%, and 60% after radiochemotherapy alone (p = 0.96). On multivariate analyses, T category (p < 0.001), N category (p = 0.004), and hemoglobin level prior to radiotherapy (p < 0.001) were associated with locoregional control. Histologic grade (p = 0.045), T category (p < 0.001), N category (p = 0.003), and hemoglobin level prior to radiotherapy (p < 0.001) were associated with metastases-free survival. Histologic grade (p = 0.030), ECOG performance status (p = 0.033), T category (p = 0.007), N category (p = 0.024) and hemoglobin level before radiotherapy (p < 0.001) were associated with overall survival.
Outcomes of radiochemotherapy alone appeared similar to those of surgery plus radio(chemo)therapy. Randomized trials comparing both treatments for different tumor sites are warranted.
非转移性 III/IV 期头颈部鳞状细胞癌的标准治疗方法在全球范围内有所不同。本研究比较了单纯放化疗与手术加放化疗（放疗加/不加同期化疗）的疗效。
对 148 例接受单纯放化疗的患者和 148 例接受手术加放化疗的患者进行数据匹配。将两组按年龄、性别、表现状态、肿瘤部位、组织学分级、T 分期、N 分期、AJCC 分期和放疗前血红蛋白水平等 9 个潜在预后因素 1:1 进行匹配，并比较局部区域控制、无转移生存和总生存情况。
手术加放化疗组 1、2、3 年局部区域控制率分别为 81%、73%和 67%，单纯放化疗组分别为 81%、74%和 65%（p=0.89）。手术加放化疗组 1、2、3 年无转移生存率分别为 86%、80%和 75%，单纯放化疗组分别为 87%、80%和 72%（p=0.57）。手术加放化疗组 1、2、3 年总生存率分别为 80%、64%和 63%，单纯放化疗组分别为 83%、68%和 60%（p=0.96）。多因素分析显示，T 分期（p<0.001）、N 分期（p=0.004）和放疗前血红蛋白水平（p<0.001）与局部区域控制有关。组织学分级（p=0.045）、T 分期（p<0.001）、N 分期（p=0.003）和放疗前血红蛋白水平（p<0.001）与无转移生存有关。组织学分级（p=0.030）、ECOG 表现状态（p=0.033）、T 分期（p=0.007）、N 分期（p=0.024）和放疗前血红蛋白水平（p<0.001）与总生存有关。
单纯放化疗的疗效似乎与手术加放化疗相似。需要进行随机试验比较两种治疗方法在不同肿瘤部位的疗效。
