Jiang Lin, Guo Liang, Wang Kejing, Wang Shengye, Fang Meiyu, Lou Jianlin
Department of Head and Neck Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China.
Department of Radiotherapy, Zhejiang Cancer Hospital, Hangzhou 310022, China.
Transl Cancer Res. 2020 Feb;9(2):901-909. doi: 10.21037/tcr.2019.12.44.
This study aimed to compare three different therapeutic models based on regional control and the outcome of locally advanced squamous cell carcinoma of the head and neck (SCCHN) after induction chemotherapy (ICT).
One hundred and twenty patients with locally advanced SCCHN were retrospectively reviewed and divided into three groups. Patients in Group A received induction chemotherapy + concurrent chemoradiotherapy (ICT + CCRT). Patients in Group B received induction chemotherapy + radical surgery + adjuvant radiotherapy with or without chemotherapy (ICT + Surgery + RT/CRT). Patients in Group C received induction chemotherapy + planned neck dissection + concurrent chemoradiotherapy (ICT + PND + CCRT). The clinicopathological characteristics, locoregional recurrence (LR), distant metastasis (DM), and overall survival (OS) were compared among them.
The median follow-up time was 20 months. In Group A, Group B and Group C, the 3-year OS was 69.7%, 72.9%, and 65.5% respectively. The LR rate was 35.1%, 26.2%, and 42.9%, respectively. The DM rate was 10.5%, 31.0%, and 9.5%, respectively. There were no significant differences in OS and LR among three groups. The DM in Group B was significantly higher than that in Group A (P<0.05), and was probably higher than that in Group C (P=0.06).
Locally advanced SCCHN has a poor prognosis, and the first treatment is critical. Individualized therapeutic regimen based on the response of ICT could be an ideal solution. As cervical metastatic lymph nodes are less sensitive to ICT than primary tumors, PND before radiation therapy might improve the regional control and throat function preservation. A multidisciplinary team (MDT) collaboration is important throughout the treatment process.
本研究旨在比较三种不同治疗模式在诱导化疗（ICT）后对头颈部局部晚期鳞状细胞癌（SCCHN）的区域控制情况及治疗结果。
回顾性分析120例局部晚期SCCHN患者，并将其分为三组。A组患者接受诱导化疗+同步放化疗（ICT+CCRT）。B组患者接受诱导化疗+根治性手术+辅助放疗（有或无化疗）（ICT+手术+RT/CRT）。C组患者接受诱导化疗+计划性颈清扫+同步放化疗（ICT+PND+CCRT）。比较三组患者的临床病理特征、局部区域复发（LR）、远处转移（DM）及总生存（OS）情况。
中位随访时间为20个月。A组、B组和C组的3年总生存率分别为69.7%、72.9%和65.5%。局部区域复发率分别为35.1%、26.2%和42.9%。远处转移率分别为10.5%、31.0%和9.5%。三组患者的总生存和局部区域复发情况无显著差异。B组的远处转移率显著高于A组（P<0.05），可能高于C组（P=0.06）。
局部晚期SCCHN预后较差，首次治疗至关重要。基于ICT反应的个体化治疗方案可能是理想的解决方案。由于颈部转移淋巴结对ICT的敏感性低于原发肿瘤，放疗前进行计划性颈清扫可能会改善区域控制并保留咽喉功能。在整个治疗过程中，多学科团队（MDT）协作很重要。
