Laccourreye O, Weinstein G, Brasnu D, Bassot V, Cauchois R, Jouffre V, Garcia D, Laccourreye H
Department of Otorhinolaryngology-Head and Neck Surgery, Laënnec Hospital, University of Paris V, France.
Cancer. 1994 Nov 15;74(10):2781-90. doi: 10.1002/1097-0142(19941115)74:10<2781::aid-cncr2820741007>3.0.co;2-u.
Vertical partial laryngectomy (VPL) and radiation therapy (RT) are the recommended conventional conservative options for glottic carcinoma classified as T2. In series presenting more than 100 patients with a minimum 3-year follow-up, however, local recurrence rates were reported as 22-43.5%. The authors' experience with a new strategy based on continuous cisplatin-fluorouracil induction chemotherapy (IC) and supracricoid partial laryngectomy with cricohyoepiglottopexy (CHEP) is presented.
A retrospective analysis of 67 patients who presented with untreated moderately to well differentiated invasive glottic carcinoma classified as T2, managed from 1983 to 1991 with IC and CHEP, was conducted. Statistical analysis of survival, local control, nodal control, distant metastasis, and metachronous second primary tumor incidence was based on the Kaplan-Meier actuarial method. Univariate analysis was performed to analyze the relationships between various factors and survival, local recurrence, and nodal recurrence. Clinical response, histologic response, IC toxicity and postoperative course were reported.
The Kaplan-Meier 5-year survival, local recurrence, nodal recurrence, distant metastasis, and metachronous second primary tumor estimate were 92.3%, 5.6%, 1.5%, 1.8%, and 5.6%, respectively. Overall laryngeal preservation was achieved in 65 patients (97%). Ultimate local control was achieved in all patients but one. Nodal recurrence was statistically more likely in patients presenting with a local recurrence. Analysis of the specimens demonstrated complete histologic response to IC in 25 (37.3%) patients. A strong statistical relation (P < 0.0001) was noted between complete clinical response after IC and complete histologic response.
The change from the prevailing treatment modalities of RT and VPL to a new multimodal strategy (IC+CHEP) did not decrease survival and allowed for an increase in laryngeal preservation rate. The high rate (37.3%) of complete histologic response suggests that IC deserves further consideration in the management of patients with glottic carcinoma classified as T2. The favorable results achieved in this series, when compared with historic controls, should stimulate prospective clinical trials comparing the two surgical procedures (CHEP vs. VPL with or without IC) for resection of Stage II glottic carcinoma.
垂直部分喉切除术（VPL）和放射治疗（RT）是推荐用于T2期声门癌的传统保守治疗方法。然而，在超过100例患者且至少随访3年的系列研究中，局部复发率报告为22%-43.5%。本文介绍了作者采用基于顺铂-氟尿嘧啶持续诱导化疗（IC）和环状软骨上部分喉切除术加环状软骨舌骨会厌固定术（CHEP）的新策略的经验。
对1983年至1991年采用IC和CHEP治疗的67例未经治疗的中度至高度分化的浸润性T2期声门癌患者进行回顾性分析。基于Kaplan-Meier精算方法对生存、局部控制、区域淋巴结控制、远处转移和异时性第二原发肿瘤发生率进行统计分析。进行单因素分析以分析各种因素与生存、局部复发和区域淋巴结复发之间的关系。报告临床反应、组织学反应、IC毒性和术后过程。
Kaplan-Meier法估计的5年生存率、局部复发率、区域淋巴结复发率、远处转移率和异时性第二原发肿瘤发生率分别为92.3%、5.6%、1.5%、1.8%和5.6%。65例患者（97%）实现了整体喉保留。除1例患者外，所有患者均实现了最终局部控制。区域淋巴结复发在出现局部复发的患者中在统计学上更常见。对标本的分析显示25例（37.3%）患者对IC有完全组织学反应。IC后完全临床反应与完全组织学反应之间存在强统计学关联（P<0.0001）。
从现行的RT和VPL治疗模式转变为新的多模式策略（IC+CHEP）并未降低生存率，且提高了喉保留率。高完全组织学反应率（37.3%）表明IC在T2期声门癌患者的治疗中值得进一步考虑。与历史对照相比，本系列取得的良好结果应促使开展前瞻性临床试验，比较两种手术方法（CHEP与VPL加或不加IC）用于切除II期声门癌。
