Lefebvre J L, Bonneterre J
Head and Neck Department, Centre Oscar Lambret, Lille, France.
Curr Opin Oncol. 1996 May;8(3):209-14. doi: 10.1097/00001622-199605000-00007.
Over the past 15 years, larynx preservation has been extensively assessed but only in the light of induction chemotherapy. From these evaluations, it appeared that the use of induction chemotherapy was safe and adequate for patient selection: irradiation with or without salvage surgery for induction chemotherapy responders and surgery with or without postoperative irradiation for induction chemotherapy nonresponders. Neither the ultimate local control nor survival worsened, and at least, half the patients retained their larynxes. Such results should not lead researchers to forget other larynx-preserving possibilities. Irradiation alone and, moreover, irradiation with modified fractionation or chemotherapy permits cure and preservation of function in many larynx and hypopharynx cases. Conversely, subtotal surgery may, in very selected cases, reach a similar goal. Finally, the new advances in imaging and biology could lead to fine tuning of patient selection. These advances could have the additional advantage of permitting use, thereafter, of chemotherapy as a real treatment and not as simply a selection parameter.
在过去的15年里，喉保留技术已得到广泛评估，但仅基于诱导化疗。从这些评估中可以看出，诱导化疗的使用对于患者选择是安全且合适的：诱导化疗有反应者接受放疗加或不加挽救性手术，诱导化疗无反应者接受手术加或不加术后放疗。最终的局部控制率和生存率均未恶化，至少有一半的患者保留了喉部。这样的结果不应使研究人员忘记其他保留喉的可能性。单纯放疗，而且是采用改良分割放疗或化疗，在许多喉和下咽病例中可实现治愈并保留功能。相反，在非常特定的病例中，次全手术可能达到类似的目标。最后，影像学和生物学方面的新进展可能会使患者选择更加精准。这些进展还可能带来额外的好处，即此后可将化疗作为一种真正的治疗方法，而不仅仅是一个选择参数。
