Norris C M, Busse P M, Clark J R
Department of Otology, Harvard Medical School, Boston, Massachusetts.
Semin Surg Oncol. 1993 Jan-Feb;9(1):3-13. doi: 10.1002/ssu.2980090103.
Chemotherapy, as preliminary treatment before surgery and/or radiation for advanced squamous cell carcinoma of the head and neck, is no longer novel. In prospective trials to date, however, multiple agent induction chemotherapy has yet to demonstrate the initial presumptive promise of improved rates of cure. As an alternate goal, there has emerged a renewed attentiveness toward limiting treatment morbidity, several strategies for which may be considered. Extirpative, often radical, surgery on the primary site of disease usually represents the most significant threat to life quality. Various ways of limiting surgical morbidity will be considered by way of introduction. The trends of head and neck cancer treatment over the decades, leading into the era of induction chemotherapy and refined radiation techniques, will be described. At the combined Dana-Farber/New England Deaconess Head and Neck Oncology Clinic, an experience with over 300 patients receiving induction chemotherapy for advanced head and neck cancer has been analyzed with an emphasis on the postulate of lessening the extent of surgery in appropriately selected patients. In a comparison between trials initiated in 1980 and 1987, improved complete response rates from 26 to 57% were documented. Survival rates were identical, but the use of planned primary site ablative surgery was decreased from 47 to 14%. While some increase in local failure has been noted in patients treated by primary site radiation alone, surgical salvage appeared to be more effective. The implication of these trends for patterns of failure and surgical salvage and data concerning the need for neck dissection in this group of patients will be briefly summarized. Other trials addressing organ-preservation strategies will also be referenced and the dichotomy between survival-based studies and morbidity-limiting studies illustrated. Independent trends in radiation technique as a potential substitute for traditional surgical practice will be reviewed.
化疗作为晚期头颈部鳞状细胞癌手术和/或放疗前的初步治疗方法，已不再新颖。然而，在迄今为止的前瞻性试验中，多药诱导化疗尚未证明其在提高治愈率方面最初假定的前景。作为一个替代目标，人们重新开始关注限制治疗的发病率，可以考虑几种实现此目标的策略。对疾病原发部位进行切除性手术，通常是根治性手术，往往是对生活质量的最大威胁。本文将介绍各种限制手术发病率的方法。还将描述数十年来头颈部癌症治疗的趋势，这些趋势引领我们进入了诱导化疗和精确放疗技术的时代。在丹娜法伯癌症研究院/新英格兰戴肯尼斯医院联合头颈肿瘤诊所，我们分析了300多名接受晚期头颈癌诱导化疗患者的情况，重点是在适当选择的患者中减少手术范围的假设。在对1980年和1987年启动的试验进行比较时，记录到完全缓解率从26%提高到了57%。生存率相同，但计划性原发部位切除手术的使用率从47%降至14%。虽然仅接受原发部位放疗的患者局部失败率有所上升，但手术挽救似乎更有效。本文将简要总结这些趋势对失败模式和手术挽救的影响，以及关于该组患者颈部淋巴结清扫必要性的数据。还将引用其他涉及器官保留策略的试验，并说明基于生存的研究和限制发病率的研究之间的分歧。作为传统手术替代方法的放疗技术的独立发展趋势也将得到回顾。
