The Role of Salvage Surgery in Patients With Recurrent Squamous Cell Carcinoma of the Oropharynx
The Role of Salvage Surgery in Patients With Recurrent Squamous Cell Carcinoma of the Oropharynx
复制标题
DOI：
10.1002/cncr.24595
复制
发表时间：
2009-12-15
期刊：
影响因子：
6.2
通讯作者：
Weber, Randal S.
中科院分区：
文献类型：
--
作者：
Zafereo, Mark E.;Hanasono, Matthew M.;Weber, Randal S.
背景：本研究的目的是全面评价初次放疗后因局部复发口咽鳞状细胞癌 (SCCOP) 接受挽救手术的患者的总体生存率、功能结果和预后因素。方法：作者回顾性分析了完成原发性 SCCOP 确定治疗的 1681 名连续患者，并确定了 168 名局部复发 SCCOP 患者，他们接受了挽救手术（41 名患者）、再放疗或近距离放射治疗（18 名患者）、姑息化疗（70 名患者）或支持治疗（39 名患者）。结果：39 名患者中有 26 名 (67%) 在挽救手术后出现第二次复发。接受挽救手术或接受再放疗、姑息化疗或支持治疗的患者的3年总生存率分别为48.7%、31.6%、3.7%和5.1%。对于接受挽救手术的患者，年龄较大 (P = .03)、缺乏无病间隔 (P < .01) 和晚期复发肿瘤分期 (P = .07) 与较低的总生存率相关。颈部疾病复发 (P = .01) 和手术切缘阳性 (P = .04) 的患者在挽救手术后复发率较高。 19例（46%）患者出现术后并发症，无围手术期死亡。从功能上看，71% 的患者表现出≥ 80% 的言语清晰度，68% 的患者能够耐受一定的口腔摄入量，87% 的患者随后需要气管切开术并拔除插管。结论：年龄、无病间隔、复发肿瘤分期、复发颈部疾病和手术切缘状态影响复发 SCCOP 挽救手术后的总生存率或复发率。尽管大多数患者具有良好的功能结果，但只有一小部分复发性 SCCOP 患者在挽救手术后实现了长期生存。癌症 2009；115：5723-33。 (C) 2009 年美国癌症协会。
BACKGROUND: The objective of this study was to comprehensively review overall survival, functional outcomes, and prognostic factors in patients who underwent salvage surgery for locally recurrent squamous cell carcinoma of the oropharynx (SCCOP) after initial radiotherapy. METHODS: The authors retrospectively reviewed 1681 consecutive patients who completed definitive therapy for primary SCCOP and identified 168 patients with locally recurrent SCCOP who underwent salvage surgery (41 patients), reirradiation or brachytherapy (18 patients), palliative chemotherapy (70 patients), or supportive care (39 patients). RESULTS: Twenty-six of 39 patients (67%) developed a second recurrence after salvage surgery. The 3-year overall survival rate for patients who underwent salvage surgery or received reirradiation, palliative chemotherapy, or supportive care were 48.7%, 31.6%, 3.7%, and 5.1%, respectively. For patients who underwent salvage surgery, older age (P = .03), the absence of a disease-free interval (P < .01), and advanced recurrent tumor stage (P = .07) were associated with lower overall survival. Patients with recurrent neck disease (P = .01) and positive surgical margins (P = .04) had higher rates of recurrence after salvage surgery. Postoperative complications occurred in 19 patients (46%), and there were no perioperative deaths. Functionally, 71% of patients demonstrated >= 80% speech intelligibility, 68% were able to tolerate some oral intake, and 87% who required a tracheotomy subsequently were decannulated. CONCLUSIONS: Age, disease-free interval, recurrent tumor stage, recurrent neck disease, and surgical margin status influenced overall survival or recurrence rate after salvage surgery for recurrent SCCOP. Although most patients had good functional outcomes, only a select group of patients with recurrent SCCOP achieved long-term survival after salvage surgery. Cancer 2009;115:5723-33. (C) 2009 American Cancer Society.