Clayman G L, Weber R S, Guillamondegui O, Byers R M, Wolf P F, Frankenthaler R A, Morrison W H, Garden A S, Hong W K, Goepfert H
Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston.
Arch Otolaryngol Head Neck Surg. 1995 Feb;121(2):219-23. doi: 10.1001/archotol.1995.01890020081015.
To compare a single institutional experience with combination chemotherapy and radiation for laryngeal preservation with historical age-, sex-, stage-, and site-matched controls who underwent laryngectomy for cancer of the larynx or hypopharynx.
Fifty-five patients with stage III or IV laryngeal and hypopharyngeal squamous carcinoma were prospectively entered into a protocol to receive three cycles of cisplatin (+/- bleomycin sulfate) and fluorouracil and radiation therapy from 1986 to 1991 (group 1). Following two cycles of chemotherapy, the clinical tumor response was assessed and responders received a third cycle of chemotherapy followed by definitive radiation therapy. Nonresponders underwent surgical salvage. Two patients in the surgical control group were matched to each protocol patient (n = 110, group 2) regarding site, stage, sex, and age (+/- 7 years) without knowledge of patient outcome.
A tertiary cancer referral center, The University of Texas M. D. Anderson Cancer Center, Houston.
Following chemotherapy, the tumor response rate for group 1 was complete in 38% and partial in 31%. With a median follow-up of 24 months (group 1) and 37 months (group 2), the Kaplan-Meier 2-year disease-specific survival for group 1 and 2 was 63% and 74%, respectively (P = .251). Among group 1 patients, 67% retained their larynges. Local recurrences were more frequent among the laryngeal preservation group (P = .001), whereas distant metastasis was more frequent among controls (P = .35). Thirty-three percent (18/55) of group 1 patients required total laryngectomy. Examining these subsets of patients showed that of the 67% (n = 37) of patients who retained their larynges, their 2-year survival was 56%, not significantly different from their respective controls (n = 74), 71%. Additionally, 2-year survival among the 18 group 1 patients who required salvage laryngectomy was 75% as compared with 80% for their matched controls (n = 36).
These results document the results of chemotherapy and radiation therapy in the treatment of patients with advanced laryngeal and hypopharyngeal cancers in preserving the larynx. Although local control is significantly compromised among these patients, there is no compromise in overall survival when combined with prompt surgical salvage.
将单一机构采用联合化疗与放疗进行喉保留治疗的经验，与历史上年龄、性别、分期和部位相匹配的因喉癌或下咽癌接受喉切除术的对照组进行比较。
1986年至1991年，55例III期或IV期喉及下咽鳞状癌患者前瞻性地进入一项方案，接受三个周期的顺铂（±硫酸博来霉素）和氟尿嘧啶以及放射治疗（第1组）。在两个周期的化疗后，评估临床肿瘤反应，有反应者接受第三个周期的化疗，随后进行根治性放射治疗。无反应者接受手术挽救。手术对照组的两名患者与每个方案患者在部位、分期、性别和年龄（±7岁）方面进行匹配（n = 110，第2组），且不了解患者的预后情况。
德克萨斯大学MD安德森癌症中心，一所三级癌症转诊中心，位于休斯顿。
化疗后，第1组的肿瘤反应率为完全缓解38%，部分缓解31%。第1组的中位随访时间为24个月，第2组为37个月，第1组和第2组的Kaplan-Meier 2年疾病特异性生存率分别为63%和74%（P = 0.251）。第1组患者中，67%保留了喉部。喉保留组的局部复发更常见（P = 0.001），而对照组的远处转移更常见（P = 0.35）。第1组33%（18/55）的患者需要行全喉切除术。对这些患者亚组进行检查发现，在保留喉部的67%（n = 37）患者中，其2年生存率为56%，与各自的对照组（n = 74）的71%无显著差异。此外，第1组中18例需要挽救性喉切除术的患者的2年生存率为75%，而其匹配对照组（n = 36）为80%。
这些结果记录了化疗和放疗在治疗晚期喉癌和下咽癌患者中保留喉部的结果。尽管这些患者的局部控制明显受损，但与及时的手术挽救相结合时，总体生存率并无影响。
