Joshi P, Patil V, Joshi A, Norohna V, Chaturvedi P, Chaukar D, Pai P, Nair D, Juvekar S, Agarwal J P, D'Cruz A K, Prabhash K
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Indian J Cancer. 2013 Jan-Mar;50(1):25-30. doi: 10.4103/0019-509X.112286.
The aim of this retrospective study was to find out the role of neo-adjuvant chemotherapy (NACT) in changing the management and outcome of advanced hypopharyngeal cancer patients.
This is a retrospective analysis of 59 treatment naïve, advanced hypopharyngeal cancer patients presenting to our tertiary care center from April 2010 to October 2011. NACT was given as two (platinum with taxane) or three drug with (platinum, taxane with 5-flurouracil [5 FU]) as 3 weekly regimen with cisplatin and docetaxel as 75 mg/m 2 each, 5-FU as 1000 mg/m 2 . NACT was either given with the intent of achieving: (1) surgical resection (extensive soft tissue disease, oropharyngeal involvement, extensive disease with cartilage erosion) or (2) organ preservation (Bulky disease with inner cartilage erosion, exolaryngeal disease without cartilage erosion, large N3 nodes).
The mean age of this population was 55 years. Most (83%) of the patients had pyriform sinus (PFS) involvement. 69% patients had Stage IVa disease, 21% Stage IVb and 10% Stage III. The overall response rate was 66%, including 06% complete responses and 60% partial responses. Following NACT, resectability was achieved in 30% (10/33) and organ preservation protocol was planned after NACT in 73% (19/26) patients. The main toxicities were neutropenia (grade 3, 4, 04%; febrile neutropenia, 4%), mucositis 5%, diarrhea 5%. The median progression free survival was 20 months.
NACT can be useful in patients with oropharyngeal involvement to achieve surgical resection and larynx preservation in patients with bulky T3 disease.
本回顾性研究旨在明确新辅助化疗（NACT）在改变晚期下咽癌患者治疗方式及预后方面的作用。
这是一项对2010年4月至2011年10月期间就诊于我们三级医疗中心的59例初治晚期下咽癌患者的回顾性分析。NACT采用两药方案（铂类联合紫杉烷）或三药方案（铂类、紫杉烷联合5-氟尿嘧啶[5-FU]），每3周进行一次，顺铂和多西他赛剂量均为75mg/m²，5-FU剂量为1000mg/m²。NACT的给药目的为：（1）实现手术切除（广泛软组织病变、口咽受累、伴有软骨侵蚀的广泛病变）或（2）器官保留（伴有内部软骨侵蚀的大块病变、无软骨侵蚀的喉外病变、巨大N3淋巴结）。
该组患者的平均年龄为55岁。大多数患者（83%）梨状窦受累。69%的患者为IVa期疾病，21%为IVb期，10%为III期。总体缓解率为66%，包括6%的完全缓解和60%的部分缓解。NACT后，30%（10/33）的患者实现了可切除性，73%（19/26）的患者在NACT后计划采用器官保留方案。主要毒性反应为中性粒细胞减少（3级、4级，4%；发热性中性粒细胞减少，4%）、黏膜炎5%、腹泻5%。无进展生存期的中位数为20个月。
NACT对于口咽受累的患者实现手术切除以及对于大块T3期疾病患者保留喉部可能是有用的。
