Zaboli David, Tan Marietta, Gogineni Hrishikesh, Lake Spencer, Fan Katherine, Zahurak Marianna L, Messing Barbara, Ulmer Karen, Zinreich Eva S, Levine Marshall A, Tang Mei, Pai Sara I, Blanco Ray G, Saunders John R, Best Simon R, Califano Joseph A, Ha Patrick K
Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Int J Otolaryngol. 2012;2012:754191. doi: 10.1155/2012/754191. Epub 2012 Jun 21.
Objective. We reviewed a cohort of patients with previously untreated locoregional advanced head and neck squamous cell carcinoma (HNSCC) who received a uniform chemoradiotherapy regimen. Methods. Retrospective review was performed of 105 patients with stage III or IV HNSCC treated at Greater Baltimore Medical Center from 2000 to 2007. Radiation included 125 cGy twice daily for a total 70 Gy to the primary site. Chemotherapy consisted of cisplatin (12 mg/m(2)/h) daily for five days and 5-fluorouracil (600 mg/m(2)/20 h) daily for five days, given with weeks one and six of radiation. All but seven patients with N2 or greater disease received planned neck dissection after chemoradiotherapy. Primary outcomes were overall survival (OS), locoregional control (LRC), and disease-free survival (DFS). Results. Median followup of surviving patients was 57.6 months. Five-year OS was 60%, LRC was 68%, and DFS was 56%. Predictors of increased mortality included age ≥55, female gender, hypopharyngeal primary, and T3/T4 stage. Twelve patients developed locoregional recurrences, and 16 patients developed distant metastases. Eighteen second primary malignancies were diagnosed in 17 patients. Conclusions. The CRT regimen resulted in favorable outcomes. However, locoregional and distant recurrences cause significant mortality and highlight the need for more effective therapies to prevent and manage these events.
目的。我们回顾了一组接受统一放化疗方案的初治局部区域晚期头颈部鳞状细胞癌（HNSCC）患者。方法。对2000年至2007年在大巴尔的摩医疗中心接受治疗的105例III期或IV期HNSCC患者进行回顾性分析。放疗包括每天两次，每次125 cGy，原发部位总剂量达70 Gy。化疗方案为顺铂（12 mg/m²/h）持续五天，5-氟尿嘧啶（600 mg/m²/20 h）持续五天，分别在放疗的第一周和第六周使用。除7例N2及以上病变患者外，所有患者在放化疗后均接受计划性颈部清扫术。主要观察指标为总生存期（OS）、局部区域控制率（LRC）和无病生存期（DFS）。结果。存活患者的中位随访时间为57.6个月。五年总生存率为60%，局部区域控制率为68%，无病生存率为56%。死亡率增加的预测因素包括年龄≥55岁女性、下咽原发肿瘤以及T3/T4期。12例患者出现局部区域复发，16例患者出现远处转移。17例患者中诊断出18例第二原发性恶性肿瘤。结论。该放化疗方案取得了良好的治疗效果。然而，局部区域和远处复发导致了显著的死亡率，凸显了需要更有效的治疗方法来预防和处理这些情况。
