Aydil Utku, Akmansu Müge, Gümüşay Özge, Eravcı Fakih Cihat, Bakkal Faruk Kadri, Yazıcı Ömer, Kızıl Yusuf, Zorlu Mehmet Ekrem, Yıldız Ramazan, Köybaşıoğlu Ahmet
1 Department of Otorhinolaryngology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey.
2 Department of Radiation Oncology, Head & Neck Surgery, Gazi University School of Medicine, Ankara, Turkey.
Ear Nose Throat J. 2019 Aug;98(7):E92-E96. doi: 10.1177/0145561319839788. Epub 2019 Apr 15.
Although definitive chemoradiation (CRT) has been used for locally advanced laryngeal cancer for more than 2 decades, studies focusing on CRT failures in advanced laryngeal cancer are scarce. In this study, we aimed to determine the failure patterns and the survival outcomes in the patients who had recurrence after concurrent CRT for laryngeal cancer. Clinical records of the patients who had definitive concurrent CRT for laryngeal cancer between 2001 and 2014 at a tertiary referral center were reviewed. The end points of the study were 1-, 2-, and 3-year overall survival (OS) and disease-specific survival (DSS).In our results, there were 48 failures and the mean time period from the first diagnosis of disease to the diagnosis of recurrence was 18.0 months (range 2-72; standard deviation: 15.6). The most common recurrence pattern was local recurrence in 21 (47.9%) patients followed by regional recurrence in 11 (22.9%) patients. The 1 and 3 years OS rates were 41.7%, and 19.2% for the entire cohort, and 64.5%, and 29.7% for the patients who had not systemic recurrence at presentation of recurrence, respectively. The 1 and 3 years DSS rates were 43.5%, and 20.0% for the entire cohort, and 69.0%, and 31.8% for the patients who had not systemic recurrence at presentation of recurrence, respectively. All patients who had systemic recurrence initially (n = 13) died within 9 months (median = 4 months, range: 1-9 months). This study reveals that survival outcomes are unfavorable in the CRT failures and careful patient selection is critical to minimize failures. In the presence of systemic recurrence, disease course is aggressive.
尽管根治性放化疗（CRT）已用于局部晚期喉癌治疗二十多年，但针对晚期喉癌CRT失败情况的研究却很匮乏。在本研究中，我们旨在确定喉癌同步CRT后复发患者的失败模式和生存结局。回顾了2001年至2014年在一家三级转诊中心接受根治性同步CRT治疗喉癌患者的临床记录。研究终点为1年、2年和3年总生存率（OS）和疾病特异性生存率（DSS）。我们的研究结果显示，共有48例治疗失败，从首次诊断疾病到复发诊断的平均时间为18.0个月（范围2 - 72个月；标准差：15.6）。最常见的复发模式是21例（47.9%）患者出现局部复发，其次是11例（22.9%）患者出现区域复发。整个队列的1年和3年OS率分别为41.7%和19.2%，复发时未出现全身复发的患者的1年和3年OS率分别为64.5%和29.7%。整个队列的1年和3年DSS率分别为43.5%和20.0%，复发时未出现全身复发的患者的1年和3年DSS率分别为69.0%和31.8%。所有最初出现全身复发的患者（n = 13）均在9个月内死亡（中位数 = 4个月，范围：1 - 9个月）。本研究表明，CRT失败患者的生存结局不佳，谨慎选择患者对于减少失败至关重要。出现全身复发时，疾病进展迅速。
