Kraus D H, Pfister D G, Harrison L B, Shah J P, Spiro R H, Armstrong J G, Fass D E, Zelefsky M, Schantz S P, Weiss M H
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Otolaryngol Head Neck Surg. 1994 Jul;111(1):31-7. doi: 10.1177/019459989411100108.
Twenty-five untreated patients with advanced, resectable squamous cell carcinoma of the hypopharynx, for whom standard treatment would have required total laryngectomy, were treated with one to three cycles of cisplatin-based chemotherapy with larynx preservation as the goal. Patients with a major (complete or partial) response to chemotherapy at the primary site were treated with definitive radiation therapy, with total laryngectomy reserved for salvage; patients with less than a partial response to chemotherapy had total laryngectomy and postoperative radiation therapy recommended. Four patients had a poor response to chemotherapy and thus were not candidates for laryngectomy. Total laryngectomy was required for initial induction chemotherapy failure in five patients and for local recurrence in five others. Three additional patients had unresectable recurrence. Successful larynx preservation was achieved in 32% (8 of 25). With a median follow-up period of 41 months, the actuarial overall and failure-free 2-year survival rates were 44% and 32%, respectively. These preliminary data suggest larynx preservation is feasible in patients with advanced lesions of the hypopharynx. Improved local and regional control must be incorporated into the larynx preservation approach for hypopharyngeal lesions. A prospective, randomized study is necessary for a more valid comparison with conventional therapy, including comparative assessments of survival, morbidity, cost and functional results.
25例未经治疗的晚期下咽鳞状细胞癌患者，其病变可切除，标准治疗本需行全喉切除术，现以保留喉功能为目标接受了1至3周期的顺铂化疗。原发部位对化疗有主要（完全或部分）反应的患者接受根治性放疗，全喉切除术留作挽救性治疗；对化疗反应不足部分反应的患者建议行全喉切除术及术后放疗。4例患者对化疗反应不佳，因此不适合行喉切除术。5例患者因初始诱导化疗失败、另5例因局部复发需要行全喉切除术。另有3例患者出现不可切除的复发。25例中有8例（32%）成功保留了喉功能。中位随访期为41个月，精算的2年总生存率和无失败生存率分别为44%和32%。这些初步数据表明，对于晚期下咽病变患者，保留喉功能是可行的。对于下咽病变的保留喉功能方法，必须纳入改善局部和区域控制。有必要进行一项前瞻性随机研究，以便与传统治疗进行更有效的比较，包括对生存、发病率、成本和功能结果的比较评估。
