Yui Mitsuko, Matsuno Yoshihisa, Furukawa Tatsuya, Teshima Masanori, Shinomiya Hirotaka, Kiyota Naomi, Nomura Tadashi, Miyawaki Daisuke, Sasaki Ryohei, Nibu Ken-Ichi
Otolaryngology - Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, JPN.
Medical Oncology and Hematology, Cancer Center, Kobe University Graduate School of Medicine, Kobe, JPN.
Cureus. 2024 Jun 17;16(6):e62553. doi: 10.7759/cureus.62553. eCollection 2024 Jun.
Background Since the larynx and pharynx are vital for respiration, swallowing, and speech, chemoradiotherapy (CRT) has been widely applied for T3 hypopharyngeal cancer (HPC) as an organ-preserving treatment. However, CRT can lead to severe late adverse events such as dysphagia and aspiration pneumonia, especially in patients who have difficulty swallowing and/or aspiration at the time of initial diagnosis. Patients and methods Between 2012 and 2020, 86 patients with T3 HPC treated with curative intent at Kobe University Hospital were included in this study. The average age was 69 years old, ranging from 43 to 89. Diseases were classified as Stage III in 29 patients, Stage IVA in 52 patients, and Stage IVB in five patients. Thirty-five (41%) patients were treated by CRT, and 51 (59%) patients were treated by surgery. Patients were followed up for at least two years, and the follow-up period ranged from four to 128 months (median: 45 months). Results Three-year progression-free survival (PFS) rates of patients treated by CRT and patients treated by surgery were 56.2% and 60.3%, respectively. Three-year disease-specific survival (DSS) rates of patients treated by CRT and surgically treated patients were 79.0% vs. 70.8%, respectively. Three-year overall survival (OS) rates of patients treated by CRT and surgically treated patients were 64.5% and 69.0%, respectively. Of note, a significant difference was observed between three-year DSS and three-year PFS (79.0% vs. 56.2%, p = 0.0014) in the patients treated by CRT but not in the patients treated by surgery. Conclusions No significant differences were observed between the PFS, DSS, and OS rates of patients treated by CRT and those of surgically treated patients. Locoregional recurrences after CRT were significantly successfully salvaged by surgical intervention. These results suggest that CRT can be applied as an alternative to surgery without reducing survival, especially for patients without severe clinical symptoms. Meticulous follow-up is mandatory for early detection of recurrence to salvage by surgery and for the management of late adverse events.
由于喉和咽对呼吸、吞咽及言语至关重要，放化疗（CRT）已被广泛应用于T3期下咽癌（HPC）作为一种保留器官的治疗方法。然而，CRT可导致严重的晚期不良事件，如吞咽困难和吸入性肺炎，尤其是在初诊时就有吞咽困难和/或误吸的患者中。
2012年至2020年期间，在神户大学医院接受根治性治疗的86例T3期HPC患者纳入本研究。平均年龄为69岁，范围从43岁至89岁。疾病分期为III期的患者有29例，IVA期的患者有52例，IVB期的患者有5例。35例（41%）患者接受了CRT治疗，51例（59%）患者接受了手术治疗。患者至少随访两年，随访期为4至128个月（中位数：45个月）。
接受CRT治疗的患者和接受手术治疗的患者的三年无进展生存率（PFS）分别为56.2%和60.3%；接受CRT治疗的患者和接受手术治疗的患者的三年疾病特异性生存率（DSS）分别为79.0%和70.8%；接受CRT治疗的患者和接受手术治疗的患者的三年总生存率（OS）分别为64.5%和69.0%。值得注意的是，接受CRT治疗的患者中观察到三年DSS和三年PFS之间存在显著差异（79.0%对56.2%，p = 0.0014），而接受手术治疗的患者中未观察到这种差异。
接受CRT治疗的患者与接受手术治疗的患者的PFS、DSS和OS率之间未观察到显著差异。CRT后的局部区域复发通过手术干预得到了显著成功挽救。这些结果表明，CRT可作为手术的替代方法应用，而不降低生存率，特别是对于没有严重临床症状的患者。必须进行细致的随访，以便早期发现复发以通过手术挽救，并管理晚期不良事件。
