Yokota Tomoya, Onitsuka Tetsuro, Hamauchi Satoshi, Shirasu Hiromichi, Onozawa Yusuke, Iida Yoshiyuki, Kamijo Tomoyuki, Mukaigawa Takashi, Okada Shinichi, Irifune Yuki, Ishida Kotaro, Ogawa Hirofumi, Onoe Tsuyoshi
Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Int J Clin Oncol. 2021 Jun;26(6):1039-1048. doi: 10.1007/s10147-021-01894-z. Epub 2021 Mar 8.
De-escalating treatments have been focused on for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). We assessed the efficacy of a triplet induction chemotherapy (ICT) followed by surgery with or without neck dissection (ND) for locally advanced OPSCC, aiming at less invasive surgery without free-flap reconstruction and avoiding postoperative irradiation.
This was a retrospective study of 41 patients with advanced resectable HPV-positive OPSCC who underwent ICT followed by surgery of primary resection with or without ND. Patients underwent triplet ICT, including docetaxel, cisplatin, and 5-fluorouracil, or carboplatin, paclitaxel, and cetuximab.
Twenty-nine patients had tonsillar cancer, 15 patients were current smokers, and 18 and 12 patients had T2N1M0 and T1N1M0 status (UICC 8th), respectively. After ICT, a surgical procedure without free-flap reconstruction and tracheostomy was possible in 90.2%. Pathological complete response at both the primary site and lymph nodes was achieved in 73.2%. Of the patients who underwent surgery, no adjuvant radiotherapy was required in 85.0%. Two patients (4.9%) experienced recurrence at regional lymph nodes, but were cured by salvage ND followed by adjuvant radiotherapy.
Upfront ICT using highly responsive triplet chemotherapeutic regimens may enable us to perform less invasive surgery without free-flap reconstruction and to avoid postoperative irradiation to the locoregional field through excellent postoperative pathological features.
降阶梯治疗一直是HPV相关口咽鳞状细胞癌（OPSCC）的关注重点。我们评估了三联诱导化疗（ICT）联合有或无颈清扫术（ND）的手术治疗局部晚期OPSCC的疗效，目标是在不进行游离皮瓣重建的情况下进行侵入性较小的手术，并避免术后放疗。
这是一项对41例晚期可切除HPV阳性OPSCC患者的回顾性研究，这些患者接受了ICT，随后进行了有或无ND的原发灶切除手术。患者接受了三联ICT，包括多西他赛、顺铂和5-氟尿嘧啶，或卡铂、紫杉醇和西妥昔单抗。
29例患者患有扁桃体癌，15例患者为现吸烟者，18例和12例患者分别处于T2N1M0和T1N1M0分期（国际抗癌联盟第8版）。ICT后，90.2%的患者可以进行不进行游离皮瓣重建和气管切开术的手术。原发灶和淋巴结的病理完全缓解率为73.2%。在接受手术的患者中，85.0%的患者不需要辅助放疗。2例患者（4.9%）出现区域淋巴结复发，但通过挽救性颈清扫术和辅助放疗治愈。
使用高反应性三联化疗方案的 upfront ICT 可能使我们能够在不进行游离皮瓣重建的情况下进行侵入性较小的手术，并通过出色的术后病理特征避免对局部区域进行术后放疗。
