Norris C M, Clark J R, Frei E, Ervin T J, Fallon B, Tuttle S A, Fabian R L, Miller D
Laryngoscope. 1986 Mar;96(3):292-302. doi: 10.1288/00005537-198603000-00011.
At the Dana-Farber Cancer Institute Head and Neck Cancer Clinic, 114 previously untreated patients with advanced squamous cell carcinoma of the head and neck (17% stage III; 83% stage IV) were managed with induction chemotherapy using cis-platinum, bleomycin, and methotrexate, followed by definitive extirpative surgery and/or radiation therapy. The present report evaluates this group from a surgical and surgical pathology standpoint. The following aspects are evaluated: predictability of, and conversion to, resectability during induction chemotherapy; ease of surgical technique and intraoperative assessment; patterns of pre-op and post-op risks and complications; gross and histopathologic observations of the extent and character of residual primary and nodal disease, particularly after a response to chemotherapy; patterns of locoregional control or failure related to treatment variables. The issues subsequently addressed include: how does chemotherapy affect the operative candidacy and resectability of proposed surgical patients? Could, or should surgery be eliminated in the management of some patients treated with induction chemotherapy? Can less radical surgery be contemplated in patients significantly "downstaged" by prior chemotherapy treatment? Is increased locoregional or distant metastatic control observed in these patients? What is the role of surgery in the responder to chemotherapy?
在达纳-法伯癌症研究所头颈癌诊所，114例先前未经治疗的晚期头颈鳞状细胞癌患者（17%为III期；83%为IV期）接受了顺铂、博来霉素和甲氨蝶呤诱导化疗，随后进行根治性切除手术和/或放射治疗。本报告从外科手术和外科病理学角度对该组患者进行评估。评估以下几个方面：诱导化疗期间可切除性的可预测性及转变情况；手术技术的难易程度和术中评估；术前和术后风险及并发症模式；残留原发性和淋巴结疾病范围及特征的大体和组织病理学观察，尤其是化疗反应后的情况；与治疗变量相关的局部区域控制或失败模式。随后讨论的问题包括：化疗如何影响拟行手术患者的手术候选资格和可切除性？在接受诱导化疗的部分患者管理中，是否可以或应该取消手术？对于因先前化疗治疗而显著“降期”的患者，是否可以考虑采用不太激进的手术？这些患者中是否观察到局部区域或远处转移控制的增加？手术在化疗反应者中起什么作用？
