Jiang Ke, Zhu Meiyan, He Shasha, Wang Chengtao, Wang Yan, Ren Yufeng, Xiang Zijun, Chen Yong
Country Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Country Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Heliyon. 2024 Oct 1;10(20):e38811. doi: 10.1016/j.heliyon.2024.e38811. eCollection 2024 Oct 30.
Stage III and IVA-B hypopharyngeal carcinoma presents a substantial risk of recurrence and metastasis. The treatment strategy remains uncertain. The objective of this observational study was to compare the outcomes of induction chemotherapy followed by radiotherapy (ICRT) and induction chemotherapy followed by chemoradiotherapy (ICCRT) in the treatment of locally advanced hypopharyngeal squamous cell carcinoma.
58 patients with stage III and IVA-B hypopharyngeal squamous cell carcinoma treated with ICRT (n = 26) or ICCRT (n = 32) were enrolled in the study. Baseline variables and toxicity rates were compared by Chi-squared test. Survival curves were constructed by the Kaplan-Meier method and compared by log-rank test. Multivariate Cox proportional hazard analysis was performed to evaluate the potential survival effects.
There were no significant differences in gender, age, smoking, drinking, T category, N category, overall stage, induction chemotherapy schemes and cycles between the two groups. The median follow-up time was 36.3 months (range, 2.3-97.5 months). The 2-year recurrence-free survival (RFS), locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and the 1-year, 2-year overall survival (OS) expressed no significant differences between the two groups. Furthermore, induction chemotherapy regimen of TPF achieved better OS than TP or PF (hazard ratio [HR] 0.395, 95 % confidence interval [CI] 0.178-0.879; = 0.023), OS of patients in N2-3 category was worse than N0-1 (HR 2.594, 95 % CI 1.230-5.471; = 0.012). In addition, the grade 3-4 therapy-associated toxicities during radiotherapy were higher in the chemoradiotherapy group than in radiotherapy alone group ( = 0.020).
Following induction chemotherapy in patients with stage III/IVA-B hypopharyngeal squamous cell carcinoma, the concurrent chemoradiotherapy regimen provided similar survival rates with radiotherapy alone. Meanwhile, the incidence of treatment-related side effects during radiotherapy after induction chemotherapy were lower than that during chemoradiotherapy.
Ⅲ期和ⅣA - B期下咽癌存在较高的复发和转移风险。治疗策略仍不明确。本观察性研究的目的是比较诱导化疗后放疗（ICRT）和诱导化疗后同步放化疗（ICCRT）治疗局部晚期下咽鳞状细胞癌的疗效。
58例接受ICRT（n = 26）或ICCRT（n = 32）治疗的Ⅲ期和ⅣA - B期下咽鳞状细胞癌患者纳入本研究。通过卡方检验比较基线变量和毒性发生率。采用Kaplan - Meier法构建生存曲线，并通过对数秩检验进行比较。进行多因素Cox比例风险分析以评估潜在的生存影响。
两组在性别、年龄、吸烟、饮酒、T分期、N分期、总体分期、诱导化疗方案和周期方面无显著差异。中位随访时间为36.3个月（范围2.3 - 97.5个月）。两组的2年无复发生存率（RFS）、局部区域无复发生存率（LRFS）、远处转移无复发生存率（DMFS）以及1年、2年总生存率（OS）均无显著差异。此外，TPF诱导化疗方案的OS优于TP或PF（风险比[HR] 0.395，95%置信区间[CI] 0.178 - 0.879；P = 0.023），N2 - 3期患者的OS低于N0 - 1期（HR 2.594，95% CI 1.230 - 5.471；P = 0.012）。另外，同步放化疗组放疗期间3 - 4级治疗相关毒性高于单纯放疗组（P = 0.020）。
对于Ⅲ/ⅣA - B期下咽鳞状细胞癌患者，诱导化疗后，同步放化疗方案与单纯放疗的生存率相似。同时，诱导化疗后放疗期间治疗相关副作用的发生率低于同步放化疗期间。
