Preoperative concurrent chemoradiotherapy plus radical surgery for advanced squamous cell carcinoma of the oral cavity: an analysis of long-term results
Preoperative concurrent chemoradiotherapy plus radical surgery for advanced squamous cell carcinoma of the oral cavity: an analysis of long-term results
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DOI：
10.1016/s1368-8375(99)00044-5
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发表时间：
1999-11-01
期刊：
影响因子：
4.8
通讯作者：
Sugimura, M
中科院分区：
文献类型：
--
作者：
Kirita, T;Ohgi, K;Sugimura, M
头颈部局部区域晚期鳞状细胞癌仍然是一个主要的临床问题。我们在1996年证明，术前同时使用顺铂或卡铂为基础的化疗和放疗加根治性手术治疗晚期口腔癌毒性最小，临床肿瘤反应率高，耐受性好，完全缓解率高，5年生存率高。本研究的目的是对晚期口腔癌的治疗方案进行长期随访。48例口腔（含软腭）鳞状细胞癌患者术前以顺铂或卡铂为基础化疗联合靶量40 Gy的同步放疗，2-6周后行根治性手术治疗。所有晚期II期（n = 7）、III期（n = 22）和IV期（n = 19）患者接受治疗，平均随访7.2年（范围：61-144个月）。所有患者5年和10年的总精算生存率为81.3%。所有患者的5年和10年无进展生存率为84.8%，II期为85.7%，III期为90.0%，IV期为78.9%。根据术前放化疗后原发肿瘤的组织病理学回归分级，10年无进展生存率为：IIa级为40.0%，IIb级为88.9%，III级为100%，IV级为87.5%。与手术切除标本中广泛残留肿瘤（IIa级）的患者相比，组织病理学反应良好的患者（IIb， III， IV级）的生存率更高（p = 0.0012）。即使在长期分析中，更好的组织学退化等级也与更高的生存率相关。这种治疗方案对晚期口腔癌产生了很高的临床和病理完全缓解和生存率，具有可接受的急性毒性特征和缺乏晚期治疗并发症。长期随访显示，即使是晚期口腔癌也没有明显的远处转移和第二原发恶性肿瘤的增加。1999爱思唯尔科学有限公司版权所有。
Locoregionally advanced squamous cell carcinomas of the head and neck continue to be a major clinical problem. We demonstrated in 1996 that preoperative concurrent cisplatin- or carboplatin-based chemotherapy and radiotherapy plus radical surgery in advanced oral cancer had minimal toxicity, had high clinical tumor response rates, was well tolerated and produced impressive complete response rates and a high 5-year survival rate. The purpose of the present study was the long-term follow-up of this treatment regimen for advanced oral carcinoma. Forty-eight patients with squamous cell carcinoma of the oral cavity (including soft palate) were treated preoperatively with cisplatin- or carboplatin-based chemotherapy in combination with simultaneous irradiation to a target volume of 40 Gy, and 2-6 weeks later underwent curative surgery. All patients with advanced Stage II (n = 7), Stage III (n = 22) and Stage IV (n = 19) were treated and followed for an average of 7.2 years (range: 61-144 months). The overall actuarial survival of all patients was 81.3% at 5 years and also at 10 years. Progression-free survival at both 5 and 10 years was 84.8% for all patients, and 85.7% for Stage II, 90.0% for Stage III, and 78.9% for Stage IV patients. Progression-free survival rates according to the histopathologic regression grade of primary tumor following preoperative chemoradiotherapy at 10 years were 40.0% for Grade IIa, 88.9% for Grade IIb, 100% for Grade III, and 87.5% for Grade IV. Patients who achieved good responses histopathologically (Grades IIb, III, IV) had superior survival rates in comparison to patients with extensive residual tumor (Grade IIa) in surgically resected specimens (p = 0.0012). A better histologic regression grade was also associated with a higher survival rate even in the long-term analysis. This treatment regimen for advanced oral cancer produced high clinical and pathologic complete response and survival rates with an acceptable acute toxicity profile and lack of late therapeutic complications. The long-term follow-up showed gratifying results even for advanced oral cancers without a substantial increase in distant metastasis and second primary malignancy. (C) 1999 Elsevier Science Ltd. All rights reserved.