Salvage surgery in post-chemoradiation laryngeal and hypopharyngeal carcinoma: outcome and review
Salvage surgery in post-chemoradiation laryngeal and hypopharyngeal carcinoma: outcome and review
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发表时间：
2015-06
影响因子：
2
通讯作者：
Van Der L. Putten;De R. Bree;P. A. Doornaert;J. Buter;S. Eerenstein;D. Rietveld;D. Kuik;C. R. Leemans
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文献类型：
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作者：
Van Der L. Putten;De R. Bree;P. A. Doornaert;J. Buter;S. Eerenstein;D. Rietveld;D. Kuik;C. R. Leemans
我们的目的是评估下咽癌和喉癌放化疗后的复发模式和挽救手术的选择，特别强调老年患者。在一项回顾性研究中，对1990年至2010年在三级医疗学术中心接受下咽癌和喉癌放化疗的所有患者进行了评价。主要结果指标是接受挽救手术的患者的生存率和并发症发生率，尤其是老年患者。次要结局指标是放化疗失败后局部复发患者挽救手术的预测因素。进行了文献综述。在纳入的136例患者中，60例患者有复发性局部疾病，其中22例接受了挽救手术。15名患者接受了全喉切除术和颈淋巴结清扫术，7名患者接受了颈淋巴结清扫术，但未接受原发肿瘤手术。在多变量分析中，60例复发性疾病患者组中挽救手术的独立预测因素为年龄中位数低于59岁（p = 0.036）和喉与下咽部（p = 0.002）。并发症发生率为68%（14%为严重并发症，54%为轻微并发症），其中23%的患者发生瘘。目前过度饮酒的患者发生的伤口相关并发症显著更多（p = 0.04）。5年无病控制率为35%，总生存率为27%，疾病特异性生存率为35%，不适合挽救手术的38例患者中位生存期为12个月。肿瘤得到控制的患者的5年总生存率为70%。在选择进行挽救手术的患者中，年龄不能预测并发症和生存率。总之，在放化疗后两年的随访中，40%的患者被诊断为复发性局部疾病。三分之一的患者接受了挽救性手术，5年疾病特异性生存率为35%，严重并发症为14%。选择接受挽救手术的老年患者与年轻患者的并发症发生率和生存率相似。
SUMMARY Our objective was to evaluate recurrence patterns of hypopharyngeal and laryngeal carcinoma after chemoradiation and options for salvage surgery, with special emphasis on elderly patients. In a retrospective study all patients who underwent chemoradiation for hypopharyngeal and laryngeal carcinoma in a tertiary care academic center from 1990 through 2010 were evaluated. Primary outcome measures were the survival and complication rates of patients undergoing salvage surgery, especially in elderly patients. Secondary outcome measures were the predictors for salvage surgery for patients with locoregional recurrence after failed chemoradiotherapy. A review of the literature was performed. Of the 136 included patients, 60 patients had recurrent locoregional disease, of whom 22 underwent salvage surgery. Fifteen patients underwent a total laryngectomy with neck dissection(s) and 7 neck dissection without primary tumour surgery. Independent predictors for salvage surgery within the group of 60 patients with recurrent disease, were age under the median of 59 years (p = 0.036) and larynx vs. hypopharynx (p = 0.002) in multivariate analyses. The complication rate was 68% (14% major and 54% minor), with fistulas in 23% of the patients. Significantly more wound related complications occurred in patients with current excessive alcohol use (p = 0.04). Five-year disease free control rate of 35%, overall survival rate of 27% and disease specific survival rate of 35% were found. For the 38 patients who were not suitable for salvage surgery, median survival was 12 months. Patients in whom the tumour was controlled had a 5-year overall survival of 70%. In patients selected for salvage surgery age was not predictive for complications and survival. In conclusion, at two years follow-up after chemoradiation 40% of the patients were diagnosed with recurrent locoregional disease. One third underwent salvage surgery with 35% 5-year disease specific survival and 14% major complications. Older patients selected for salvage surgery had a similar complication rate and survival as younger patients.