Luna-Oritz K, Villavicencio-Valencia V, Rodriguez-Falconi A, Alvarez-Avitia M, Granados-Garcia M, Cano-Valdez A M, Peteuil N
B-ENT. 2016;12(4):271-277.
Induction chemotherapy followed by supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEF) in T3NO arytenoid fixation-related glottic cancer.
Arytenoid fixation in the larynx has been considered a contraindication for performing organ preservation surgery (OPS). We present a retrospective series of cases of arytenoid fixation-related T3N0 glottic cancer treated by neoadjuvant chemotherapy followed by OPS.
Retrospective review of 19 patients (from 2008 to 2012) with T3NO glottic cancer who received two cycles of neoadjuvant chemotherapy with a combination of paclitaxel, cisplatin and 5-fluoruracil (PPF), with a 21-day interval between each cycle, followed by supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP).
Sixteen patients with a mean age of 56.4 years received neoadjuvant chemotherapy with a clinical response (7 partial response/9 complete response) and radiologic response by computed tomography (CT) (7 partial response/7 complete response/2 cases without CT) were treated with SCPL-CHEP and removal of the arytenoid cartilage in the tumour site (10 left/6 right), bilateral neck dissection of levels II to V and searching of the Delphian node. There was one patient who died after a recurrence in the larynx and who also had an additional concomitant second primary tumour, and a second patient with a second primary tumour in the lung, who is still alive after treatment. Disease-free survival (DFS) was 82.5% at 5 years and overall survival (OS) was 80% at 5 years.
Neoadjuvant chemotherapy proved beneficial in patients waiting for surgery, helped maximize the oncologic benefit of the surgery provided (good local control using SCPL with CHEP), improved regional and distant control, minimized side effects by avoiding treatment with radiotherapy whenever possible, and proved feasible even in the presence of ipsilateral arytenoid fixation. Our results are encouraging, although a multi-centre randomized clinical trial should be performed in order to identify the true impact of this approach.
对于T3N0声门癌，先进行诱导化疗，然后行环状软骨上部分喉切除术（SCPL）联合环舌会厌固定术（CHEF）。
喉内杓状软骨固定一直被视为进行器官保留手术（OPS）的禁忌证。我们回顾性分析了一系列新辅助化疗后行OPS治疗的杓状软骨固定相关T3N0声门癌病例。
回顾性分析2008年至2012年期间19例T3N0声门癌患者，他们接受了两个周期的新辅助化疗，化疗方案为紫杉醇、顺铂和5-氟尿嘧啶（PPF）联合，每个周期间隔21天，随后行环状软骨上部分喉切除术（SCPL）联合环舌会厌固定术（CHEP）。
16例平均年龄56.4岁的患者接受了新辅助化疗，临床有效（7例部分缓解/9例完全缓解），计算机断层扫描（CT）显示影像学有效（7例部分缓解/7例完全缓解/2例未行CT检查），这些患者接受了SCPL-CHEP手术，切除肿瘤部位的杓状软骨（10例左侧/6例右侧），双侧II至V区颈部淋巴结清扫及Delphian淋巴结探查。有1例患者喉复发后死亡，该患者还伴有另一个第二原发肿瘤，另1例患者肺部有第二原发肿瘤，治疗后仍存活。5年无病生存率（DFS）为82.5%，5年总生存率（OS）为80%。
新辅助化疗对等待手术的患者有益，有助于使所施行手术的肿瘤学获益最大化（使用SCPL联合CHEP实现良好的局部控制），改善区域和远处控制，尽可能避免放疗以减少副作用，并且即使存在同侧杓状软骨固定也证明是可行的。我们的结果令人鼓舞，尽管应该进行多中心随机临床试验以确定这种方法的真正影响。
