N2/3 分期下咽癌诱导化疗后颈部转移淋巴结的管理
The management of metastatic neck nodes following induction chemotherapy in N2/3 classification hypopharyngeal carcinoma.
作者信息
Li Feiran, Hsueh Chiyao, Gong Hongli, Zhu Yi, Tao Lei, Zhou Liang, Wang Shengzi, Zhang Ming
机构信息
Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.
Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China.
出版信息
Head Neck. 2022 Sep;44(9):2009-2017. doi: 10.1002/hed.27106.
BACKGROUND
For patients with less chemosensitive neck nodes, poor prognosis after chemoradiotherapy (CRT) could be predicted and neck dissection is needed.
METHODS
Ninety-two N2/3 hypopharyngeal carcinoma patients were retrospectively studied. According to response after induction chemotherapy (ICT), patients were treated with neck dissection followed by concurrent CRT (CCRT) (group 1), surgery plus postoperative CRT (group 2), or CCRT for primary and regional sites (group 3).
RESULTS
Overall survival and disease-free survival rates of group 1 were significantly higher than group 2 (p = 0.038, p = 0.031) and group 3 (both p = 0.018). Regional control rate of group 1 was significantly higher than group 3 (p = 0.041). There were no significant differences between groups 1 and 2 regarding local and regional control (p = 0.746, p = 0.302).
CONCLUSIONS
Neck dissection followed by CCRT is the best choice for patients with responsive primary but nonresponsive nodes.
背景
对于颈部淋巴结化疗敏感性较低的患者，放化疗（CRT）后预后较差，可能需要进行颈部清扫术。
方法
对92例N2/3期下咽癌患者进行回顾性研究。根据诱导化疗（ICT）后的反应，患者接受颈部清扫术，随后进行同步放化疗（CCRT）（第1组）、手术加术后放化疗（第2组）或对原发灶和区域淋巴结进行CCRT（第3组）。
结果
第1组的总生存率和无病生存率显著高于第2组（p = 0.038，p = 0.031）和第3组（p均 = 0.018）。第1组的区域控制率显著高于第3组（p = 0.041）。第1组和第2组在局部和区域控制方面无显著差异（p = 0.746，p = 0.302）。
结论
对于原发灶有反应但淋巴结无反应的患者，颈部清扫术联合CCRT是最佳选择。
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