Department of Clinical Oncology, St. James's Institute of Oncology, Beckett Street, Leeds LS9 7TF, United Kingdom.
Oral Oncol. 2013 Jan;49(1):55-9. doi: 10.1016/j.oraloncology.2012.07.010. Epub 2012 Aug 1.
The optimal management of the N3 neck in head and neck squamous cell carcinoma (HNSCC) remains controversial. We report the outcomes of patients with N3 disease treated with a strategy of concurrent chemo-radiotherapy (CRT)±induction chemotherapy (ICT) without a planned neck dissection.
Forty patients with HNSCC N3 disease treated between January 2004 and December 2010 were retrospectively identified. Inclusion criteria for the study were: non-nasopharyngeal HNSCC, N3 nodal disease, intention to treat with CRT±ICT.
Median age was 60 (range 39-74). Median follow up was 32 months (range 8-88). 34 (85%) of patients received ICT. 35 patients received cisplatin-CRT, 4 carboplatin-CRT and 1 patient was treated with radiotherapy alone due to ICT toxicity. 27 (67.5%) patients had a complete response (CR) to CRT. 5 (12.5%) patients had an incomplete response in both the primary and nodal sites. 8 (20%) patients had a CR in the primary site but incomplete in the nodal regions. The crude rate of regional failure following a CR was 3/27 (11.2%). Isolated regional failure occurred in 1/27 (3.7%) patients who had achieved a CR post-CRT. 3 year overall survival, disease free survival, locoregional control, local control and regional control in the whole cohort were 51.4%, 49.6%, 65.7%, 77.3%, 69.3%, and in patients with a CR were 73.3%, 70.0%, 86.6%, 90.5% and 91.7% respectively.
Isolated regional nodal failure is rare following a complete response to CRT for N3 HNSCC managed without a planned neck dissection.
头颈部鳞状细胞癌（HNSCC）中 N3 颈部的最佳治疗方法仍存在争议。我们报告了采用同期放化疗（CRT）±诱导化疗（ICT）策略治疗而未行计划颈部清扫术的 N3 疾病患者的治疗结果。
回顾性分析 2004 年 1 月至 2010 年 12 月期间治疗的 40 例 HNSCC N3 疾病患者。该研究的纳入标准为：非鼻咽癌、N3 淋巴结疾病、意向治疗采用 CRT±ICT。
中位年龄为 60 岁（范围 39-74 岁）。中位随访时间为 32 个月（范围 8-88 个月）。34 例（85%）患者接受 ICT。35 例患者接受顺铂-CRT，4 例患者接受卡铂-CRT，1 例患者因 ICT 毒性而单独接受放疗。27 例（67.5%）患者 CRT 完全缓解（CR）。5 例（12.5%）患者原发灶和淋巴结部位均不完全缓解。8 例（20%）患者原发灶 CR 但淋巴结区域不完全缓解。CR 后区域性失败的粗率为 3/27（11.2%）。在 27 例获得 CRT 后 CR 的患者中，孤立性区域性失败发生 1 例（3.7%）。全队列的 3 年总生存率、无病生存率、局部区域控制率、局部控制率和区域控制率分别为 51.4%、49.6%、65.7%、77.3%和 69.3%，CR 患者分别为 73.3%、70.0%、86.6%、90.5%和 91.7%。
对于未行计划颈部清扫术的 N3 HNSCC 患者，在 CRT 完全缓解后，孤立性区域淋巴结失败很少见。
