Melong Jonathan C, Rigby Matthew H, Bullock Martin, Hart Robert D, Trites Jonathan R B, Taylor S Mark
Division of Otolaryngology - Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
J Otolaryngol Head Neck Surg. 2015 Sep 30;44:39. doi: 10.1186/s40463-015-0093-3.
The optimal treatment strategy for oropharyngeal squamous cell carcinoma is highly debated. However, growing evidence supports the use of minimally invasive techniques, such as transoral laser microsurgery (TLM), as a first-line treatment modality for these carcinomas. The purpose of our study was to assess the efficacy and safety of TLM for the treatment of primary and recurrent oropharyngeal carcinomas.
All patients with oropharyngeal carcinoma undergoing TLM at the QEII Health Sciences Centre in Halifax, Nova Scotia were identified within a prospective database monitoring TLM outcomes. Kaplan-Meier survival analysis was used to evaluate the following end points at 36 months: local control (LC), disease-specific survival (DSS), and disease-free survival (DFS). Safety endpoints included complications following surgery and long term morbidity related to TLM.
Between 2003 and 2014, 39 patients with oropharyngeal carcinoma underwent TLM resection. Twenty-eight (72%) patients had primary carcinoma, nine (23%) were radiation/chemoradiation (RT/CRT) failures, and two (5%) had second primaries following previous RT/CRT. Three patients had stage I disease, 8 stage II, 5 stage III, and 23 stage IV disease. HPV status was available for 26 patients, of which 23 (88%) had HPV positive disease. Kaplan-Meier estimates of 36-month LC, DSS, and DFS for primary oropharyngeal carcinomas were 85.5% (SE 10.6%), 85.7% (SE 13.2%) and 77.7% (SE 12.5%) respectively. Thirty-six-month outcomes for RT/CRT failures were 66.76% (SE 15.7%) for LC and 55.6% (SE 16.6%) for DSS and DFS. Three patients developed complications following surgery.
Observed 36-month efficacy and safety outcomes support the use of TLM for the treatment of primary and recurrent oropharyngeal carcinoma.
口咽鳞状细胞癌的最佳治疗策略存在高度争议。然而，越来越多的证据支持将微创技术，如经口激光显微手术（TLM），作为这些癌症的一线治疗方式。我们研究的目的是评估TLM治疗原发性和复发性口咽癌的疗效和安全性。
在一个监测TLM结果的前瞻性数据库中，识别出所有在新斯科舍省哈利法克斯的QEII健康科学中心接受TLM治疗的口咽癌患者。采用Kaplan-Meier生存分析在36个月时评估以下终点：局部控制（LC）、疾病特异性生存（DSS）和无病生存（DFS）。安全终点包括手术后的并发症以及与TLM相关的长期发病率。
2003年至2014年期间，39例口咽癌患者接受了TLM切除。28例（72%）患者为原发性癌，9例（23%）为放疗/放化疗（RT/CRT）失败患者，2例（5%）为先前RT/CRT后的第二原发性癌。3例患者为I期疾病，8例为II期，5例为III期，23例为IV期疾病。26例患者可获得人乳头瘤病毒（HPV）状态，其中23例（88%）为HPV阳性疾病。原发性口咽癌36个月的LC、DSS和DFS的Kaplan-Meier估计值分别为85.5%（标准误10.6%）、85.7%（标准误13.2%）和77.7%（标准误12.5%）。RT/CRT失败患者的36个月结局，LC为66.76%（标准误15.7%），DSS和DFS为55.6%（标准误16.6%）。3例患者术后出现并发症。
观察到的36个月疗效和安全性结果支持使用TLM治疗原发性和复发性口咽癌。
