Zelefsky M J, Kraus D H, Pfister D G, Raben A, Shah J P, Strong E W, Spiro R H, Bosl G J, Harrison L B
Department of Radiation Oncology, Memorial-Sloan Kettering Cancer Center, New York, New York 10021, USA.
Head Neck. 1996 Sep-Oct;18(5):405-11. doi: 10.1002/(SICI)1097-0347(199609/10)18:5<405::AID-HED3>3.0.CO;2-9.
Although the standard therapy for locally advanced hypopharyngeal cancer remains surgery and postoperative radiotherapy (RT), alternative treatment approaches include induction chemotherapy and RT. The purpose of this retrospective study was to compare the long-term outcome of these treatments performed in a single institution.
Twenty-six patients with advanced, resectable, squamous cell carcinoma of the hypopharynx were treated with induction chemotherapy and definitive RT (group I), reserving laryngectomy for salvage. The induction phase of therapy consisted of 2-3 cycles of cisplatin-based chemotherapy followed by conventional fractionated RT to doses of 66-70 Gy. The outcomes of this group of patients were compared with the outcomes of 30 patients with hypopharyngeal cancer who were treated at our institution with surgery and postoperative RT (group II). The median follow-up times of the surviving patients in groups I and II were 5 and 9 years, respectively.
The local recurrence-free survival at 5 years from the completion of therapy for group I was 50%, compared with 69% for group II (p = .41). Among patients with T3-T4 primary tumors, the 5-year local control rates were 58% and 59% for groups I and II, respectively (p = .78). The likelihood of larynx preservation, free of local disease at 5 years for group I, was 52%. The 5-year neck recurrence-free survival for groups I and II were 47% and 69%, respectively (p = .66). Among patients with N2-N3 stage disease, the 5-year incidence of neck failure for groups I and II were 73% and 68%, respectively (p = .74). The 5-year distant metastases-free survival for groups I and II were 67% and 57%, respectively (p = .19). The 5-year disease-free survival rates for groups I and II were 30% and 42%, respectively (p = .9). The 5-year overall survival rates for groups I and II were 15% and 22%, respectively (p = .65).
Nonsurgical therapy for advanced stage hypopharyngeal cancer provides survivorship comparable with that achieved with standard approaches of surgery and postoperative RT. However, despite the therapy, the outcome is poor. Future studies will need to explore new treatment strategies in an effort to improve upon the outcome for this group of patients.
尽管局部晚期下咽癌的标准治疗方法仍是手术及术后放疗（RT），但替代治疗方法包括诱导化疗和放疗。这项回顾性研究的目的是比较在单一机构中进行的这些治疗的长期结果。
26例晚期、可切除的下咽鳞状细胞癌患者接受诱导化疗和根治性放疗（I组），保留喉切除术用于挽救治疗。治疗的诱导阶段包括2 - 3个周期的以顺铂为基础的化疗，随后进行常规分割放疗，剂量为66 - 70 Gy。将该组患者的结果与在本机构接受手术及术后放疗的30例下咽癌患者的结果进行比较（II组）。I组和II组存活患者的中位随访时间分别为5年和9年。
I组治疗完成后5年的局部无复发生存率为50%，而II组为69%（p = 0.41）。在T3 - T4期原发性肿瘤患者中，I组和II组的5年局部控制率分别为58%和59%（p = 0.78）。I组5年时无局部疾病的喉保留可能性为52%。I组和II组的5年颈部无复发生存率分别为47%和69%（p = 0.66）。在N2 - N3期疾病患者中，I组和II组的5年颈部失败发生率分别为73%和68%（p = 0.74）。I组和II组的5年无远处转移生存率分别为67%和57%（p = 0.19）。I组和II组的5年无病生存率分别为30%和42%（p = 0.9）。I组和II组的5年总生存率分别为15%和22%（p = 0.65）。
晚期下咽癌的非手术治疗提供的生存率与标准的手术及术后放疗方法相当。然而，尽管进行了治疗，结果仍然很差。未来的研究需要探索新的治疗策略，以努力改善这组患者的治疗结果。
