Surgical Resection Is Necessary To Maximize Tumor Control in Function-Preserving, Aggressive Chemoradiation Protocols for Advanced Squamous Cancer of the Head and Neck (Stage III and IV)
Surgical Resection Is Necessary To Maximize Tumor Control in Function-Preserving, Aggressive Chemoradiation Protocols for Advanced Squamous Cancer of the Head and Neck (Stage III and IV)
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在针对晚期头颈鳞状癌（III 期和 IV 期）的功能保留、积极放化疗方案中，为了最大限度地控制肿瘤，必须进行手术切除
DOI：
10.1007/s10434-001-0644-x
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发表时间：
2001
影响因子：
3.7
通讯作者：
T. Kennedy
中科院分区：
文献类型：
--
作者：
H. Wanebo;P. Chougule;N. Ready;H. Safran;W. Ackerley;R. J. Koness;R. McRae;P. Nigri;L. Leone;K. Radie;P. Reiß;T. Kennedy
背景：在积极的放化疗方案中的作用，先进的头部和颈部cancer. Methods：手术切除的作用受到质疑，因为引用高的临床反应率在许多series.Methods：每周紫杉醇，卡铂，放射治疗的积极新辅助治疗方案的作用进行了检查，第三和第四阶段的放射完成72戈伊，如果活检在原发部位是阴性后，管理的45戈伊。在入组的43例患者中，38例完成了方案。结果：38例中完全缓解（45戈伊后原发灶活检阴性）25例（66%）。在N1至N3淋巴结的患者中，颈淋巴结清扫术显示22%存在残留淋巴结转移。手术切除原发灶13例，其中喉癌5例，舌根癌2例。4例患者因晚期口底癌行下颌骨切除重建术，1例患者因鼻-上颌癌行切除重建术。12例患者中9例进行了功能性切除。中位随访50个月时，中位无进展生存率和总生存率分别为64%和68%。9例患者复发（3例局部复发，6例远处复发）。颈部无失效。挽救手术进行了一个病人与本地和一个遥远的diseases.Conclusions：手术切除是积极的放化疗方案，以确保在原发部位和颈部肿瘤控制的重要组成部分。
Background:The role of surgery in aggressive chemoradiation protocols for advanced head and neck cancer has been questioned because of the quoted high clinical response rates in many series.Methods:The role of surgical resection was examined in an aggressive neoadjuvant protocol of weekly paclitaxel, carboplatin, and radiation for stage III and IV with completion of radiation to 72 Gy if biopsy at the primary site was negative after administration of 45 Gy. Of 43 patients enrolled, 38 completed the protocol. The clinical response was 100% (including 18 complete and 20 partial responses).Results:The complete pathologic response (negative primary site biopsy at 45 Gy) was 25 of 38 (66%). Of patients who presented with N1 to N3 nodes, neck dissection revealed residual nodal metastases in 22%. Surgical resection of the primary site was required in 13 patients, including 5 with larynx cancer and 2 with base of tongue cancers. Four patients had resection with reconstruction for advanced mandible floor of mouth cancer, and one had resection of nasal-maxillary cancer. Functional resection was performed in 9 of 12 patients. The median progression free and overall survival was 64% and 68%, respectively, at median follow-up of 50 months. Nine patients developed recurrence (three local and six distant). There were no failures in the neck. Salvage surgery was performed in one patient with local and one with distant disease.Conclusions:Surgical resection is an essential component of aggressive chemoradiation protocols to ensure tumor control at the primary site and in the neck.
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DOI：
10.1200/jco.1994.12.12.2682
发表时间：
1994
期刊：
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