Mada Yusuke, Koshitsuka Keiichi, Ihara Fumie, Ueki Yuji, Konno Akiyoshi
Nihon Jibiinkoka Gakkai Kaiho. 2014 Jun;117(6):794-801. doi: 10.3950/jibiinkoka.117.794.
We report herein on 32 cases of head and neck carcinoma with cervical lymph node metastases treated by radiotherapy and concomitant intraarterial cisplatin (RADPLAT) from April 2009 to May 2013. N3 cases revealed residual disease of the cervical lymph nodes in 7/9 cases. Among the 22 patients excluding N1 and N3 cases, the pathological CR rate was 63.6%. Among the 13 patients in whom the anticancer drug was directly infused into the cervical lymph nodes, the pathological CR rate was 76.9%, whereas in the 9 patients without direct infusion of the cervical lymph nodes, the pathological CR rate was 44.4%. Therefore, we recommend the direct infusion into cervical lymph node metastases for not only N3 cases but also N2 cases if a feeding artery is identified easily. When clinical examination after RADPLAT leads to suspected residual disease, neck dissection should be adapted. If the clinical examination leads to a diagnosis of CR, we recommend a biopsy of the original cervical lymph nodes because the cases which we diagnosed as CR revealed residual disease of the cervical lymph nodes in 4/16.
我们在此报告2009年4月至2013年5月期间，32例接受放疗联合动脉内顺铂（RADPLAT）治疗的伴有颈部淋巴结转移的头颈部癌患者。N3病例中，9例中有7例颈部淋巴结出现残留病灶。在排除N1和N3病例的22例患者中，病理完全缓解率为63.6%。在13例将抗癌药物直接注入颈部淋巴结的患者中，病理完全缓解率为76.9%，而在9例未直接注入颈部淋巴结的患者中，病理完全缓解率为44.4%。因此，我们建议，对于N3病例以及如果能轻易识别供血动脉的N2病例，均应将抗癌药物直接注入颈部淋巴结转移灶。当RADPLAT治疗后的临床检查怀疑有残留病灶时，应进行颈部清扫术。如果临床检查诊断为完全缓解，我们建议对原颈部淋巴结进行活检，因为在我们诊断为完全缓解的病例中，16例中有4例颈部淋巴结出现残留病灶。
