局部晚期喉鳞状细胞癌患者接受根治性放疗与喉切除术后辅助放疗的疗效：转诊癌症中心的真实世界经验
Outcomes of definitive radiotherapy vs. laryngectomy followed by adjuvant radiotherapy in patients with locally advanced laryngeal squamous cell carcinoma: real-world experience in a referral cancer center.
作者信息
Kazemian Ali, Esmati Ebrahim, Ghalehtaki Reza, Farazmand Borna, Mousavi-Darzikolaee Nima, Bayani Reyhaneh, Razmkhah Mahdieh, Taherioun Maryam, Saeedi Niloufar, Heidari Farrokh, Zakeri Kaveh
机构信息
Department of Radiation Oncology, Cancer Institute, IKHC, Tehran University of Medical Sciences, Tehran, Iran.
Radiation Oncology Research Center (RORC), Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
Radiat Oncol. 2024 Dec 18;19(1):180. doi: 10.1186/s13014-024-02565-9.
BACKGROUND
Laryngeal cancer is a common head and neck cancer. Surgical treatment can impair patients' voice and swallowing function, making definitive radiotherapy a viable alternative for locally advanced cases.
METHODS
To compare the outcomes of definitive versus adjuvant radiotherapy in patients with primary locally advanced laryngeal cancer, we retrospectively evaluated consecutive patients treated from 2007 to 2020. We assessed and compared the median and 3-year overall survival (OS), disease-free survival (DFS), distant metastasis control (DMC), and local recurrence-free survival (LRC) in all patients and in T4 patients exclusively.
RESULTS
One hundred patients were studied, including definitive (N = 64) and adjuvant (N = 36) radiotherapy. The median follow-up was 29 months. Overall, the median OS in the definitive vs. adjuvant group was 100 months (95%CI = 46.5-153.5) vs. not reached, respectively (log-rank P = 0.506). The median DFS in the definitive vs. adjuvant group was 20 months (95%CI = 7.7-32.3) vs. not reached, respectively (log-rank P = 0.148). Three-year OS and DFS rates in all patients were 64% (95%CI: 48-78) vs. 75% (95%CI: 55-95) and 43% (95%CI:29-57) vs. 61% (95%CI: 41-81) in the definitive vs. adjuvant groups, respectively. Among T4 patients, the median OS in the definitive RT group vs. adjuvant group was not reached vs. 48 (95%CI = 0-105.3), respectively (log-rank P = 0.788). The median DFS in the definitive RT group vs. adjuvant group was 12 months (95%CI = 9.34-14.65) vs. 36 months (95%CI = 4.4-67.5), respectively (log-rank P = 0.868). Three-year OS and DFS rates were 71% (95%CI: 42-100) vs. 75% (95%CI: 50-100) and 40% (95%CI:21-79) vs. 56% (95%CI: 25-87) in the definitive vs. adjuvant groups, respectively.
CONCLUSIONS
Our analysis suggests that definitive radiotherapy in laryngeal cancer does not lead to a poorer outcome than total laryngectomy followed by adjuvant radiotherapy. In T4 patients, our findings should reassure clinicians and patients about the viability of definitive radiotherapy as a treatment approach.
背景
喉癌是一种常见的头颈部癌症。手术治疗会损害患者的发声和吞咽功能，这使得根治性放疗成为局部晚期病例的一种可行替代方案。
方法
为比较原发性局部晚期喉癌患者接受根治性放疗与辅助性放疗的效果，我们回顾性评估了2007年至2020年连续治疗的患者。我们评估并比较了所有患者以及仅T4患者的中位生存期和3年总生存期（OS）、无病生存期（DFS）、远处转移控制（DMC）和局部无复发生存期（LRC）。
结果
共研究了100例患者，包括根治性放疗组（N = 64）和辅助性放疗组（N = 36）。中位随访时间为29个月。总体而言，根治性放疗组与辅助性放疗组的中位OS分别为100个月（95%CI = 46.5 - 153.5）和未达到（log-rank P = 0.506）。根治性放疗组与辅助性放疗组的中位DFS分别为20个月（95%CI = 7.7 - 32.3）和未达到（log-rank P = 0.148）。所有患者中，根治性放疗组与辅助性放疗组的3年OS率分别为64%（95%CI：48 - 78）和75%（95%CI：55 - 95），3年DFS率分别为43%（95%CI：29 - 57）和61%（95%CI：41 - 81）。在T4患者中，根治性放疗组与辅助性放疗组的中位OS分别为未达到和48个月（95%CI = 0 - 105.3）（log-rank P = 0.788）。根治性放疗组与辅助性放疗组的中位DFS分别为12个月（95%CI = 9.34 - 14.65）和36个月（95%CI = 4.4 - 67.5）（log-rank P = 0.868）。根治性放疗组与辅助性放疗组的3年OS率分别为71%（95%CI：42 - 100）和75%（95%CI：50 - 100），3年DFS率分别为40%（95%CI：21 - 79）和56%（95%CI：25 - 87）。
结论
我们的分析表明，喉癌的根治性放疗并不比全喉切除术后辅助性放疗的效果差。对于T4患者，我们的研究结果应能让临床医生和患者放心，根治性放疗作为一种治疗方法是可行的。
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