Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Laryngoscope. 2014 Sep;124(9):2075-80. doi: 10.1002/lary.24695. Epub 2014 May 2.
OBJECTIVES/HYPOTHESIS: Local residual or recurrent pharyngeal cancer after definitive radiotherapy (RT) or chemoradiotherapy (CRT) is correlated to poor prognosis. We analyzed the efficacy of salvage surgery for patients with local residual or recurrent pharyngeal cancer after RT or CRT.
Retrospective clinical study with chart review.
Between 2001 and 2011, we treated 207 patients with resectable pharyngeal cancer, including 98 patients with oropharyngeal cancer (OPC) and 109 patients with hypopharyngeal cancer (HPC) who received definitive RT or CRT. Local residual or recurrence developed in 59 patients (23 with OPC; 36 with HPC), of whom 42 (18 with OPC; 24 with HPC) underwent salvage surgery. These 42 patients were investigated in this study.
The initial treatments were RT; RT with induction chemotherapy (IC); and concurrent CRT in 12, 9, and 21 patients, respectively. The median radiation dose was 70 Gy. The 3-year disease-specific survival rate after salvage surgery was 40% (median, 26 months). The significant prognostic factors were stage IV prior to initial therapy (P = .049), development of concurrent local and regional relapse (P = .02), and OPC (P = .04).
The efficacy of salvage surgery for local residual or recurrent pharyngeal cancer was limited. Oropharynx origin, stage IV prior to initial therapy, and concurrent regional relapses were significantly poor prognostic factors. Salvage surgery for HPC is worth challenging aggressively. Conversely, the indication of salvage surgery for OPCs should be carefully considered because of its low cure rate.
目的/假设：根治性放疗（RT）或放化疗（CRT）后局部残留或复发性咽癌与预后不良相关。我们分析了挽救性手术治疗 RT 或 CRT 后局部残留或复发性咽癌患者的疗效。
回顾性临床研究，病历回顾。
2001 年至 2011 年间，我们治疗了 207 例可切除咽癌患者，其中 98 例为口咽癌（OPC）患者，109 例为下咽癌（HPC）患者，接受了根治性 RT 或 CRT。59 例患者（23 例 OPC；36 例 HPC）出现局部残留或复发，其中 42 例（18 例 OPC；24 例 HPC）接受了挽救性手术。本研究对这 42 例患者进行了调查。
初始治疗分别为 RT；RT 联合诱导化疗（IC）；同期 CRT，患者分别为 12、9 和 21 例。中位放疗剂量为 70Gy。挽救性手术后 3 年疾病特异性生存率为 40%（中位 26 个月）。初始治疗前 IV 期（P=0.049）、局部和区域同时复发（P=0.02）和 OPC（P=0.04）是显著的预后因素。
挽救性手术治疗局部残留或复发性咽癌的疗效有限。口咽癌起源、初始治疗前 IV 期和同期区域复发是显著的不良预后因素。积极挑战治疗 HPC 的挽救性手术是值得的。相反，由于 OPC 的治愈率低，应谨慎考虑对其进行挽救性手术的适应证。
