Long-Term Results of RTOG 91-11: A Comparison of Three Nonsurgical Treatment Strategies to Preserve the Larynx in Patients With Locally Advanced Larynx Cancer
Long-Term Results of RTOG 91-11: A Comparison of Three Nonsurgical Treatment Strategies to Preserve the Larynx in Patients With Locally Advanced Larynx Cancer
复制标题
DOI：
10.1200/jco.2012.43.6097
复制
发表时间：
2013-03-01
影响因子：
45.3
通讯作者：
Cooper, Jay S.
中科院分区：
文献类型：
--
作者：
Forastiere, Arlene A.;Zhang, Qiang;Cooper, Jay S.
目的报道组间放射治疗肿瘤学组91-11研究的长期结果，评价化疗加放射治疗(RT)在保喉方面的作用。患者与方法将III或IV期声门型或声门上型鳞癌患者随机分为诱导顺铂/氟尿嘧啶(PF)组(对照组)、同期顺铂/RT组(RT组)或单纯RT组。以无喉切除生存(LFS)的综合终点为主要终点。存活患者的中位随访期为10.8年。两种化疗方案均较单纯放疗显著改善LFS(诱导化疗与单纯放疗：风险比[HR]，0.75；95%CI，0.59至0.95；P=0.02；伴随化疗与单纯RT：HR，0.78；95%CI，0.78至0.98；P=.03)。总体存活率没有显著差异，尽管伴随着与诱导化疗相关的更差结果的可能性(HR，1.25；95%CI，0.98至1.61；P=.08)。联合应用顺铂/放疗可显著提高喉保留率(HR，0.58；95%CI，0.37~0.89；P=.0050)和单纯RT(P=.001)，而诱导PF再RT并不优于单纯RT(HR，1.26；95%CI，0.88~1.82；P=.35)。晚期反应无差异，但同期化疗的死亡率较高(诱导化疗组为30.8%，单纯RT组为16.9%)。结论10年来的研究结果表明，诱导PF+RT和顺铂/RT对LFS的综合终点疗效相似。与单纯诱导臂或单纯放疗相比，联合应用顺铂/放疗可显著提高局部控制率和喉保留率。需要新的策略，以更低的发病率改善器官保存和功能。J Clin Oncol31：845-852。(C)2012年美国临床肿瘤学会
PurposeTo report the long-term results of the Intergroup Radiation Therapy Oncology Group 91-11 study evaluating the contribution of chemotherapy added to radiation therapy (RT) for larynx preservation.Patients and MethodsPatients with stage III or IV glottic or supraglottic squamous cell cancer were randomly assigned to induction cisplatin/fluorouracil (PF) followed by RT (control arm), concomitant cisplatin/RT, or RT alone. The composite end point of laryngectomy-free survival (LFS) was the primary end point.ResultsFive hundred twenty patients were analyzed. Median follow-up for surviving patients is 10.8 years. Both chemotherapy regimens significantly improved LFS compared with RT alone (induction chemotherapy v RT alone: hazard ratio [HR], 0.75; 95% CI, 0.59 to 0.95; P = .02; concomitant chemotherapy v RT alone: HR, 0.78; 95% CI, 0.78 to 0.98; P = .03). Overall survival did not differ significantly, although there was a possibility of worse outcome with concomitant relative to induction chemotherapy (HR, 1.25; 95% CI, 0.98 to 1.61; P = .08). Concomitant cisplatin/RT significantly improved the larynx preservation rate over induction PF followed by RT (HR, 0.58; 95% CI, 0.37 to 0.89; P = .0050) and over RT alone (P = .001), whereas induction PF followed by RT was not better than treatment with RT alone (HR, 1.26; 95% CI, 0.88 to 1.82; P = .35). No difference in late effects was detected, but deaths not attributed to larynx cancer or treatment were higher with concomitant chemotherapy (30.8% v 20.8% with induction chemotherapy and 16.9% with RT alone).ConclusionThese 10-year results show that induction PF followed by RT and concomitant cisplatin/RT show similar efficacy for the composite end point of LFS. Locoregional control and larynx preservation were significantly improved with concomitant cisplatin/RT compared with the induction arm or RT alone. New strategies that improve organ preservation and function with less morbidity are needed. J Clin Oncol 31:845-852. (C) 2012 by American Society of Clinical Oncology