Wu Jin, Hu Guohua, Li Minmin, Wang Zhihai, Ma Wei, Wang Xiaoqiang, Zhu Jiang, Pan Min, Zeng Quan
Department of Otorhinologyngology，the First Affiliated Hospital of Chongqing Medical University，Chongqing，400016，China.
Department of Oncology，the First Affiliated Hospital of Chongqing Medical University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Sep;37(9):715-720;728. doi: 10.13201/j.issn.2096-7993.2023.09.006.
To evaluate the clinical significance of neoadjuvant immunotherapy combined with chemotherapy in the treatment of larynx preservation in locally advanced hypopharyngeal squamous cell carcinoma. Patients with locally advanced HPSCC（cT3-T4aN0-N3M0） were eligible. All received 2 cycles of pembrolizumab combined with docetaxel and platinum neoadjuvant induction therapy. After two cycles, the efficacy was evaluated, followed by radical chemoradiotherapy or surgery and adjuvant chemoradiotherapy according to the efficacy. The primary endpoints were objective response rate（ORR） ，larynx-preservation（LP） rate at 3 months post-treatment and the adverse reactions during neoadjuvant therapy. From December 2021 to December 2022, 10 patients with locally advanced HPSCC（cT3-T4aN0-N3M0） were enrolled. After 2 cycles of the neoadjuvant therapy, 2 patients achieved complete response（CR）, 7 patients achieved partial response（PR）, 1 patient was stable disease（SD）, objective response rate（ORR） was 90%, and disease control rate（DCR） was 100%. 5 patients received radical chemoradiotherapy, 5 patients received surgery and adjuvant chemoradiotherapy, four of them received partial laryngectomy and partial hypopharyngeal resection surgery, and one of them received total laryngectomy and partial hypopharyngeal resection surgery. All patients were able to withstand adverse reactions of neoadjuvant therapy and successfully completed the whole treatment of HPSCC without grade 3-4 treatment-related adverse reactions. There was no recurrence or metastasis during 3-18 months of follow-up. 1 patient died of severe pneumonia 3 months after the completion of radical chemoradiotherapy. At 3 months after treatment, the larynx-preservation rate was 80%. Neoadjuvant immunotherapy combined with chemotherapy has good short-term efficacy and the adverse reactions were tolerable. It can improve the larynx-preservation rate of patients with locally advanced HPSCC, thus improving the prognosis and quality of life of patients.
评估新辅助免疫治疗联合化疗在局部晚期下咽鳞状细胞癌保喉治疗中的临床意义。符合条件的患者为局部晚期下咽鳞状细胞癌（cT3 - T4aN0 - N3M0）患者。所有患者均接受2周期帕博利珠单抗联合多西他赛和铂类新辅助诱导治疗。两个周期后评估疗效，然后根据疗效进行根治性放化疗或手术及辅助放化疗。主要终点为客观缓解率（ORR）、治疗后3个月的保喉（LP）率以及新辅助治疗期间的不良反应。2021年12月至2022年12月，纳入10例局部晚期下咽鳞状细胞癌（cT3 - T4aN0 - N3M0）患者。新辅助治疗2周期后，2例患者达到完全缓解（CR），7例患者达到部分缓解（PR），1例患者病情稳定（SD），客观缓解率（ORR）为90%，疾病控制率（DCR）为100%。5例患者接受根治性放化疗，5例患者接受手术及辅助放化疗，其中4例接受部分喉切除术和部分下咽切除术，1例接受全喉切除术和部分下咽切除术。所有患者均能耐受新辅助治疗的不良反应，并成功完成下咽鳞状细胞癌的全程治疗，无3 - 4级治疗相关不良反应。随访3 - 18个月期间无复发或转移。1例患者在根治性放化疗完成3个月后死于重症肺炎。治疗后3个月，保喉率为80%。新辅助免疫治疗联合化疗具有良好的短期疗效，不良反应可耐受。它可以提高局部晚期下咽鳞状细胞癌患者的保喉率，从而改善患者的预后和生活质量。
