van Doeveren Thérèse E M, Karakullukçu M Barış, van Veen Robert L P, Lopez-Yurda Marta, Schreuder Willem H, Tan I Bing
Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Department of Biostatistics, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Laryngoscope. 2018 Mar;128(3):657-663. doi: 10.1002/lary.26792. Epub 2017 Aug 8.
In case of close or positive resection margins after oncological resection in head and neck surgery, additional treatment is necessary. When conventional options are exhausted, photodynamic therapy (PDT) can play a role in achieving clear margins. The purpose of the current study was to evaluate the clinical benefit of PDT as adjuvant therapy next to surgery with positive resection margins. The role of the time interval between surgery and PDT on survival outcomes also was investigated.
Retrospective cohort analysis.
Adjuvant PDT was performed in patients with a malignancy in the head and neck region with close or positive resection margins who were not eligible for conventional treatment options. The primary endpoint was progression-free survival. Secondary endpoints were disease-free survival, overall survival, and optimal time interval between surgery and PDT.
Fifty-four patients were treated with surgery followed by meta-tetrahydroxyphenylchlorin-mediated PDT. There was a large diversity in tumor location and histopathology, as well as in time interval between surgery and PDT. The 2-year progression-free survival rate was 30%; 2-year disease-free survival rate was 28%; and 2-year overall survival was 51%. Disease-free survival was significantly better when the time interval between surgery and PDT was ≥ 6 weeks (P = 0.02).
PDT can be applied as adjuvant therapy after surgery in cases of a malignancy with close or positive tumor resection margins. However, the clinical benefits are yet to be determined. There is a significantly better disease-free survival with a time interval between surgery and PDT of minimal 6 weeks.
在头颈部肿瘤切除术后切缘接近或阳性的情况下，需要进行额外治疗。当常规治疗方法用尽时，光动力疗法（PDT）可在实现切缘阴性方面发挥作用。本研究的目的是评估PDT作为手术切缘阳性患者辅助治疗的临床益处。还研究了手术与PDT之间的时间间隔对生存结果的影响。
回顾性队列分析。
对头颈部恶性肿瘤且切缘接近或阳性、不符合常规治疗条件的患者进行辅助PDT治疗。主要终点是无进展生存期。次要终点是无病生存期、总生存期以及手术与PDT之间的最佳时间间隔。
54例患者接受了手术，随后进行了间-四羟基苯基氯啉介导的PDT治疗。肿瘤位置、组织病理学以及手术与PDT之间的时间间隔存在很大差异。2年无进展生存率为30%；2年无病生存率为28%；2年总生存率为51%。当手术与PDT之间的时间间隔≥6周时，无病生存期显著更好（P = 0.02）。
对于肿瘤切除切缘接近或阳性的恶性肿瘤患者，PDT可作为手术后的辅助治疗方法。然而，其临床益处尚待确定。手术与PDT之间的时间间隔至少为6周时，无病生存期显著更好。
4。《喉镜》，2018年，第128卷，第657 - 663页。
