Chenal C, Julienne V, Fleury F, Desprez P
Centre régional de lutte contre le cancer, Rennes, France.
Bull Cancer Radiother. 1996;83(1):54-9.
From 1986 to 1992, 55 cases of PPWC were treated with a conservative intent at the Regional Cancer Center (Rennes, France) and Saint-Yves Center (Vannes, France): 16 oropharyngeal posterior wall carcinoma (OP) and 39 hypopharyngeal posterior wall (HP); the mean age of the population was 60.3 years (31-81 years). A previous and simultaneous head and neck cancer was noted in 15 and 13% of cases respectively. Half of the cases (55%) were T1 T2 tumors and 82% were N0 N1. Except for three patients treated by curietherapy (5%), all patients were treated by radiotherapy (RT) alone (75%) or associated with curietherapy (7%) or partial pharyngectomy (13%). 15% received neoadjuvant chemotherapy, mainly for T3 tumors. With a followup of 4-88 months (mean: 23 months) 38% of patients are still alive; 8% of loco-regionally controlled patients died of second cancer or intercurrent disease. The tumor control was 67%. The nodes control was 90%. During the course of the disease, 19% of patients had metastases. The complete response at the end of treatment was 78%. Among these patients, 54% remained definitively free of disease. There is no difference between OP and HP. The analysis of survival curves showed the following points: significant difference between T1 T2, and T2 T3 (P < 0.05), N0 N1 and N2 N3 (P < 0.03), well differentiated histology or not (P < 0.02), RT alone or associated with curietherapy or surgery (P < 0.03) even for limited tumors T1 T2 N0 N1 (P < 0.03). There was no significant difference between group treated or not by chemotherapy even for T3 tumors. These findings do not differ if we consider either OP or HP. We conclude that OP and HP have the same prognostic factors and must be considered as the same clinical entity. For limited tumors T1 T2 N0 N1, patients managed by radiotherapy associated with complementary local treatment (conservative surgery or curietherapy) do better than patients treated by RT alone (plateau 80% at 18 months+vs plateau 25% at 12 months +). For these limited tumors, our recommendation is to treat patients by external RT (50 Gy) and curietherapy boost (20 Gy) rather than by conservative surgery and external RT (70 Gy). These two treatments have the same efficacity but the first one is expected to diminish late complications of RT. Neo adjuvant chemotherapy does not seen to improve survival even for advanced tumors. Generally speaking these results remain poor for locally advanced desease and for undifferentiated tumors. These patients need a new therapeutic approach (concomittant radio-chemotherapy, hyper or hypofonctionnated RT).
1986年至1992年期间，法国雷恩地区癌症中心和法国瓦讷圣伊夫中心对55例后壁咽癌患者进行了保守治疗：16例口咽后壁癌（OP）和39例下咽后壁癌（HP）；患者的平均年龄为60.3岁（31 - 81岁）。分别有15%和13%的病例曾患过及同时患有头颈癌。半数病例（55%）为T1 T2期肿瘤，82%为N0 N1期。除3例接受近距离放疗（5%）外，所有患者均单独接受放射治疗（RT）（75%），或联合近距离放疗（7%）或部分咽切除术（13%）。15%的患者接受了新辅助化疗，主要针对T3期肿瘤。随访4 - 88个月（平均23个月），38%的患者仍存活；8%局部区域控制的患者死于第二原发癌或并发疾病。肿瘤控制率为67%。淋巴结控制率为90%。在疾病过程中，19%的患者发生了转移。治疗结束时的完全缓解率为78%。在这些患者中，54%最终无病生存。OP和HP之间无差异。生存曲线分析显示以下几点：T1 T2与T2 T3之间存在显著差异（P < 0.05），N0 N1与N2 N3之间存在显著差异（P < 0.03），组织学分化良好与否存在显著差异（P < 0.02），单独放疗或联合近距离放疗或手术存在显著差异（P < 0.03），即使对于局限性肿瘤T1 T2 N0 N1也是如此（P < 0.03）。即使对于T3期肿瘤，接受化疗或未接受化疗的组之间也无显著差异。如果分别考虑OP或HP，这些结果并无不同。我们得出结论，OP和HP具有相同的预后因素，必须被视为同一临床实体。对于局限性肿瘤T1 T2 N0 N1，接受放疗联合辅助局部治疗（保守手术或近距离放疗）的患者比单独接受放疗的患者预后更好（18个月及以上时平台期为80%，而12个月及以上时平台期为25%）。对于这些局限性肿瘤，我们的建议是采用外照射放疗（50 Gy）和近距离放疗增敏（20 Gy）治疗患者，而不是采用保守手术和外照射放疗（70 Gy）。这两种治疗方法疗效相同，但预计第一种方法可减少放疗的晚期并发症。新辅助化疗即使对于晚期肿瘤似乎也不能提高生存率。一般来说，这些结果对于局部晚期疾病和未分化肿瘤仍然较差。这些患者需要一种新的治疗方法（同步放化疗、高或低功能放疗）。
