Laryngeal preservation for advanced laryngeal and hypopharyngeal cancers.
Laryngeal preservation for advanced laryngeal and hypopharyngeal cancers.
复制标题
晚期喉癌和下咽癌的喉部保留。
DOI：
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
H. Goepfert
中科院分区：
文献类型：
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作者：
G. Clayman;Randal S. Weber;O. Guillamondegui;R. Byers;P. Wolf;R. Frankenthaler;William H. Morrison;A. Garden;W. K. Hong;H. Goepfert
目的
比较一个单一的机构的经验，联合化疗和放疗的喉保护与历史年龄，性别，阶段和地点匹配的对照谁接受了喉切除术的喉癌或下咽癌。
设计
1986年至1991年，55例III期或IV期喉和下咽鳞状细胞癌患者前瞻性地进入一项方案，接受三个周期的顺铂（+/-硫酸博莱霉素）和氟尿嘧啶和放射治疗（组1）。在两个周期的化疗后，评估临床肿瘤反应，反应者接受第三个周期的化疗，然后进行明确的放射治疗。无应答者接受了手术挽救。在不了解患者结局的情况下，手术对照组中的2例患者与每例方案患者（n = 110，第2组）在部位、分期、性别和年龄（+/- 7岁）方面相匹配。
设置
一个三级癌症转诊中心，德克萨斯大学M。D.休斯顿安德森癌症中心。
结果
化疗后，第1组的肿瘤反应率为38%和31%。中位随访时间为24个月（第1组）和37个月（第2组），第1组和第2组的Kaplan-Meier 2年疾病特异性生存率分别为63%和74%（P = .251）。在第1组患者中，67%保留了喉。局部复发在喉保留组中更常见（P = 0.001），而远处转移在对照组中更常见（P = 0.35）。第1组中33%（18/55）的患者需要全喉切除术。对这些患者亚组的检查显示，在67%（n = 37）保留喉的患者中，其2年生存率为56%，与各自的对照组（n = 74）71%无显著差异。此外，第1组18例需要挽救性喉切除术的患者的2年生存率为75%，而其匹配对照组（n = 36）为80%。
结论
这些结果记录了晚期喉癌和下咽癌患者在保留喉的治疗中化疗和放疗的结果。虽然这些患者的局部控制能力明显受损，但结合及时的手术挽救，总体生存率没有降低。
OBJECTIVE
To compare a single institutional experience with combination chemotherapy and radiation for laryngeal preservation with historical age-, sex-, stage-, and site-matched controls who underwent laryngectomy for cancer of the larynx or hypopharynx.
DESIGN
Fifty-five patients with stage III or IV laryngeal and hypopharyngeal squamous carcinoma were prospectively entered into a protocol to receive three cycles of cisplatin (+/- bleomycin sulfate) and fluorouracil and radiation therapy from 1986 to 1991 (group 1). Following two cycles of chemotherapy, the clinical tumor response was assessed and responders received a third cycle of chemotherapy followed by definitive radiation therapy. Nonresponders underwent surgical salvage. Two patients in the surgical control group were matched to each protocol patient (n = 110, group 2) regarding site, stage, sex, and age (+/- 7 years) without knowledge of patient outcome.
SETTING
A tertiary cancer referral center, The University of Texas M. D. Anderson Cancer Center, Houston.
RESULTS
Following chemotherapy, the tumor response rate for group 1 was complete in 38% and partial in 31%. With a median follow-up of 24 months (group 1) and 37 months (group 2), the Kaplan-Meier 2-year disease-specific survival for group 1 and 2 was 63% and 74%, respectively (P = .251). Among group 1 patients, 67% retained their larynges. Local recurrences were more frequent among the laryngeal preservation group (P = .001), whereas distant metastasis was more frequent among controls (P = .35). Thirty-three percent (18/55) of group 1 patients required total laryngectomy. Examining these subsets of patients showed that of the 67% (n = 37) of patients who retained their larynges, their 2-year survival was 56%, not significantly different from their respective controls (n = 74), 71%. Additionally, 2-year survival among the 18 group 1 patients who required salvage laryngectomy was 75% as compared with 80% for their matched controls (n = 36).
CONCLUSIONS
These results document the results of chemotherapy and radiation therapy in the treatment of patients with advanced laryngeal and hypopharyngeal cancers in preserving the larynx. Although local control is significantly compromised among these patients, there is no compromise in overall survival when combined with prompt surgical salvage.