Weiss Bernhard G, Ihler Friedrich, Wolff Hendrik A, Schneider Simon, Canis Martin, Steiner Wolfgang, Welz Christian
Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany.
University Medical Center Göttingen, Göttingen, Germany.
Head Neck. 2017 Aug;39(8):1631-1638. doi: 10.1002/hed.24814. Epub 2017 May 5.
The oncologic and functional outcome of transoral laser microsurgery (TLM) for primary treatment of hypopharyngeal cancer was examined in a multimodal treatment concept.
Two hundred eleven patients with squamous cell carcinoma (SCC) of the hypopharynx (pT1-4a, pN0-2, M0) were treated by TLM +/- neck dissection (88%) +/- (chemo)radiotherapy ([C]RT; 51%). The majority of cases were advanced stages III and IVa (85%).
The 5-year Kaplan-Meier estimates for local control after TLM were pT category-related 88.1%, 74.8%, 77.3%, and 61.8% for pT1-4a tumors. The 5-year estimates of overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) for early stages I and II were 68.2%, 96.7%, and 74.6%, respectively; for stage III they were 65.9%, 83.8%, and 56.4%, respectively; and the rates for stage IVa were 44.5%, 60.7%, and 50.3%, respectively. Overall, 95.7% of the patients maintained regular oral nutrition without feeding tube dependency.
Primary TLM in multimodal concepts of treatment (+/- neck dissection, +/- [C]RT) offers favorable oncologic results as compared with other therapeutic regimes.
在多模式治疗理念下，对口咽癌的经口激光显微手术（TLM）的肿瘤学和功能结局进行了研究。
211例下咽鳞状细胞癌（SCC）患者（pT1 - 4a，pN0 - 2，M0）接受了TLM治疗，其中88%的患者接受了颈部清扫术，51%的患者接受了（化疗）放疗（[C]RT）。大多数病例为晚期III期和IVa期（85%）。
TLM术后5年的Kaplan - Meier局部控制率估计值显示，pT1 - 4a肿瘤分别为88.1%、74.8%、77.3%和61.8%。早期I期和II期患者的5年总生存率（OS）、疾病特异性生存率（DSS）和无复发生存率（RFS）分别为68.2%、96.7%和74.6%；III期患者分别为65.9%、83.8%和56.4%；IVa期患者分别为44.5%、60.7%和50.3%。总体而言，95.7%的患者维持正常经口营养，无需依赖鼻饲管。
与其他治疗方案相比，多模式治疗（±颈部清扫术，±[C]RT）中的原发性TLM可提供良好的肿瘤学效果。
