Debenham Brock J, Banerjee Robyn, Warkentin Heather, Ghosh Sunita, Scrimger Rufus, Jha Naresh, Parliament Matthew
Department of Oncology, University of Alberta.
Department of Oncology, University of Calgary.
Cureus. 2016 Jul 26;8(7):e713. doi: 10.7759/cureus.713.
To compare and contrast the patterns of failure in patients with locally advanced squamous cell oropharyngeal cancers undergoing curative-intent treatment with primary surgery or radiotherapy +/- chemotherapy.
Two hundred and thirty-three patients with stage III or IV oropharyngeal squamous cell carcinoma who underwent curative-intent treatment from 2006-2012, were reviewed. The median length of follow-up for patients still alive at the time of analysis was 4.4 years. Data was collected retrospectively from a chart review.
One hundred and thirty-nine patients underwent primary surgery +/- adjuvant therapy, and 94 patients underwent primary radiotherapy +/- chemotherapy (CRT). Demographics were similar between the two groups, except primary radiotherapy patients had a higher age-adjusted Charleston co-morbidity score (CCI). Twenty-nine patients from the surgery group recurred; 15 failed distantly only, seven failed locoregionally, and seven failed both distantly and locoregionally. Twelve patients recurred who underwent chemoradiotherapy; ten distantly alone, and two locoregionally. One patient who underwent radiotherapy (RT) alone failed distantly. Two and five-year recurrence-free survival rates for patients undergoing primary RT were 86.6% and 84.9% respectively. Two and five-year recurrence-free survival rates for primary surgery was 80.9% and 76.3% respectively (p=0.21). There was no significant difference in either treatment when they were stratified by p16 status or smoking status.
Our analysis does not show any difference in outcomes for patients treated with primary surgery or radiotherapy. Although the primary pattern of failure in both groups was distant metastatic disease, some local failures may be preventable with careful delineation of target volumes, especially near the base of skull region.
比较和对比接受根治性手术或放疗±化疗的局部晚期口咽鳞状细胞癌患者的失败模式。
回顾了2006年至2012年期间接受根治性治疗的233例III期或IV期口咽鳞状细胞癌患者。分析时仍存活患者的中位随访时间为4.4年。数据通过病历回顾进行回顾性收集。
139例患者接受了原发手术±辅助治疗，94例患者接受了原发放疗±化疗（同步放化疗）。两组患者的人口统计学特征相似，但原发放疗患者的年龄校正Charleston合并症评分（CCI）较高。手术组有29例患者复发；15例仅远处转移失败，7例局部区域失败，7例远处和局部区域均失败。接受放化疗的患者中有12例复发；10例仅远处转移，2例局部区域复发。1例仅接受放疗的患者远处转移失败。接受原发放疗患者的2年和5年无复发生存率分别为86.6%和84.9%。原发手术的2年和5年无复发生存率分别为80.9%和76.3%（p=0.21）。按p16状态或吸烟状态分层时，两种治疗方法均无显著差异。
我们的分析未显示原发手术或放疗患者的治疗结果有任何差异。虽然两组的主要失败模式是远处转移性疾病，但通过仔细勾画靶区，尤其是在颅底区域附近，一些局部失败可能是可以预防的。
