Single-cycle induction chemotherapy selects patients with advanced laryngeal cancer for combined chemoradiation: A new treatment paradigm
Single-cycle induction chemotherapy selects patients with advanced laryngeal cancer for combined chemoradiation: A new treatment paradigm
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DOI：
10.1200/jco.2005.01.2047
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发表时间：
2006-02-01
影响因子：
45.3
通讯作者：
Taylor, J
中科院分区：
文献类型：
--
作者：
Urba, S;Wolf, G;Taylor, J
目的与单纯放疗或常规喉切除术相比，晚期喉癌患者的初次放化疗可在不影响生存的情况下获得较高的器官保留率。适当选择患者的器官保存方法可以提高整体治疗效果和生活质量。我们对III期和IV期喉癌患者进行了一项II期器官保存试验，以确定是否可以通过选择对单周期诱导化疗有反应的患者进行器官保存来降低晚期挽救手术率并提高生存率。患者和方法化疗方案为顺铂100 mg/m2，第1天，氟尿嘧啶1，000 mg/m2/d，共5天。缓解率低于50%的患者立即行喉切除术。达到50%以上反应的患者继续进行同步放化疗。放化疗后的组织学完全反应者再接受两个周期的化疗。结果在97例符合条件的患者中，73例（75%）达到50%以上的反应并接受了放化疗。共有29例患者（30%）接受了挽救手术; 19例患者（20%）在单周期诱导化疗后接受了早期挽救手术，3例患者（3%）在放化疗后接受了晚期挽救手术，6例患者（6%）最终因复发接受了挽救手术，1例患者因软骨放射性坏死接受了喉切除术。中位随访时间为41.9个月。3年总生存率为85%。病因特异性生存率为87%。69例（70%）保留了喉功能。结论与以往的结果相比，这些结果证实了良好的喉保留和提高总生存率。
Purpose Primary chemoradiotherapy in patients with advanced laryngeal cancer can achieve high rates of organ preservation without sacrificing survival compared with radiation alone or conventional laryngectomy. Appropriate selection of patients for organ preservation approaches could enhance overall treatment outcome and quality of life. We conducted a phase II organ preservation trial for patients with stage III and IV larynx cancer to determine whether late salvage surgery rates could be decreased and survival improved by selecting patients for organ preservation based on response to a single cycle of induction chemotherapy.Patients and Methods The chemotherapy was cisplatin 100 mg/m(2) on day 1 and fluorouracil 1,000 mg/m(2)/d for 5 days. Patients who achieved less than 50% response had immediate laryngectomy. Patients who achieved more than 50% response went on to concurrent chemoradiotherapy. Histologic complete responders after chemoradiotherapy received two more cycles of chemotherapy. Patients with residual disease after chemoradiotherapy had planned salvage surgery.Results Of 97 eligible patients, 73 (75%) achieved more than 50% response and received chemoradiotherapy. A total of 29 patients (30%) had salvage surgery; 19 patients (20%) had early salvage surgery after the single cycle of induction chemotherapy, three patients (3%) had late salvage surgery after chemoradiotherapy, six patients (6%) eventually had salvage surgery for recurrence, and one patient had laryngectomy for chondroradionecrosis. The median follow-up time was 41.9 months. The overall survival rate at 3 years is 85%. The cause-specific survival rate was 87%. Larynx preservation was achieved in 69 patients (70%).Conclusion These results confirm excellent larynx preservation and improved overall survival rates compared with historical results.