Yanagi Takeshi, Shibamoto Yuta, Ogino Hiroyuki, Baba Fumiya, Murai Taro, Nagai Aiko, Miyakawa Akifumi, Sugie Chikao
Department of Radiology, Nagoya City University Graduate School of Medical Sciences.
Kurume Med J. 2016;62(1-2):1-8. doi: 10.2739/kurumemedj.MS65003. Epub 2016 Mar 1.
The outcomes of induction chemotherapy followed by radiotherapy for hypopharyngeal carcinoma were analyzed to determine whether response to induction chemotherapy could be a useful parameter for selecting candidates for organ-preserving therapy.Forty-three patients with hypopharyngeal carcinoma were treated with definitive radiotherapy with or without concurrent chemotherapy following induction chemotherapy. The predominant induction chemotherapy regimens involved cisplatin and 5-fluorouracil with or without docetaxel. The patients that responded to the induction chemotherapy received definitive organ-preserving treatment. Patients who did not respond to induction chemotherapy were considered for surgery, but only those patients who underwent definitive radiotherapy were analyzed in this study. Conventional radiotherapy was administered in all patients. The associations between clinical parameters including age, sex, performance status (PS), tumor site, T-category, N-category, stage, the regimen of induction chemotherapy, the response to induction chemotherapy, the presence/absence of concurrent chemotherapy, overall survival (OS), and local control (LC) were analyzed.Among the surviving patients, the follow-up period ranged from 10-145 months (median: 46 months). The 3-year OS and LC rates for all 43 patients were 61% and 70%, respectively. The 3-year OS and LC rates of the responders were 73% and 81%, respectively, whereas those of the non-responders were 29% and 40%, respectively. In multivariate analysis, only PS was correlated with overall survival (p=0.03). The complication rates were acceptable in all groups.Responders to induction chemotherapy appear to be good candidates for definitive organ-preserving treatment. Chemoselection appears to aid treatment selection in patients with hypopharyngeal carcinoma.
对下咽癌诱导化疗后再行放疗的结果进行分析，以确定诱导化疗的反应是否可作为选择保留器官治疗候选者的有用参数。43例下咽癌患者在诱导化疗后接受了有或无同步化疗的根治性放疗。主要的诱导化疗方案包括顺铂和5-氟尿嘧啶，有或无多西他赛。对诱导化疗有反应的患者接受了根治性的保留器官治疗。对诱导化疗无反应的患者考虑手术，但本研究仅分析了那些接受根治性放疗的患者。所有患者均接受了常规放疗。分析了包括年龄、性别、体能状态（PS）、肿瘤部位、T分期、N分期、阶段、诱导化疗方案、诱导化疗反应、同步化疗的有无、总生存期（OS）和局部控制（LC）等临床参数之间的关联。在存活患者中，随访期为10 - 145个月（中位数：46个月）。43例患者的3年总生存率和局部控制率分别为61%和70%。有反应者的3年总生存率和局部控制率分别为73%和81%，而无反应者分别为29%和40%。在多因素分析中，只有体能状态与总生存期相关（p = 0.03）。所有组的并发症发生率均可接受。诱导化疗有反应者似乎是根治性保留器官治疗的良好候选者。化疗选择似乎有助于下咽癌患者的治疗选择。
