INDUCTION CHEMOTHERAPY PLUS RADIATION COMPARED WITH SURGERY PLUS RADIATION IN PATIENTS WITH ADVANCED LARYNGEAL-CANCER
INDUCTION CHEMOTHERAPY PLUS RADIATION COMPARED WITH SURGERY PLUS RADIATION IN PATIENTS WITH ADVANCED LARYNGEAL-CANCER
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DOI：
10.1056/nejm199106133242402
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发表时间：
1991-06-13
影响因子：
158.5
通讯作者：
WOLF, GT
中科院分区：
文献类型：
--
作者：
WOLF, GT
背景。我们对未接受治疗的晚期（III期或IV期）喉癌患者进行了一项前瞻性、随机研究，比较诱导化疗后放射治疗与常规喉切除术和术后放射治疗的结果。332名患者被随机分配接受三个周期的化疗（顺铂和氟尿嘧啶）和放射治疗或手术和放射治疗。两个化疗周期后评估临床肿瘤反应，有反应的患者接受第三个周期，随后接受最终放疗（6600至7600 cGy）。化疗和放疗后肿瘤无反应或局部复发的患者可行补救性喉切除术。经过两个周期的化疗，31%的患者临床肿瘤反应完全，54%的患者部分缓解。中位随访33个月后，两个治疗组的2年生存率均为68%(95%可信区间，60 - 76%)（P = 0.9846）。两组之间的复发模式有显著差异，化疗组的局部复发（P = 0.0005）多于手术组，远处转移（P = 0.016）较少。化疗组共有59例患者（36%）需要全喉切除术。总的来说，64%的患者和64%的存活且无疾病的患者保留了喉部。这些初步结果提示了化疗在晚期喉癌患者中的新作用，并表明诱导化疗和明确放疗的治疗策略可以有效地保护大部分患者的喉部，而不会影响总生存率。
Background. We performed a prospective, randomized study in patients with previously untreated advanced (Stage III or IV) laryngeal squamous carcinoma to compare the results of induction chemotherapy followed by definitive radiation therapy with those of conventional laryngectomy and postoperative radiation.Methods. Three hundred thirty-two patients were randomly assigned to receive either three cycles of chemotherapy (cisplatin and fluorouracil) and radiation therapy or surgery and radiation therapy. The clinical tumor response was assessed after two cycles of chemotherapy, and patients with a response received a third cycle followed by definitive radiation therapy (6600 to 7600 cGy). Patients in whom there was no tumor response or who had locally recurrent cancers after chemotherapy and radiation therapy underwent salvage laryngectomy.Results. After two cycles of chemotherapy, the clinical tumor response was complete in 31 percent of the patients and partial in 54 percent. After a median follow-up of 33 months, the estimated 2-year survival was 68 percent (95 percent confidence interval, 60 to 76 percent) for both treatment groups (P = 0.9846). Patterns of recurrence differed significantly between the two groups, with more local recurrences (P = 0.0005) and fewer distant metastases (P = 0.016) in the chemotherapy group than in the surgery group. A total of 59 patients in the chemotherapy group (36 percent) required total laryngectomy. The larynx was preserved in 64 percent of the patients overall and 64 percent of the patients who were alive and free of disease.Conclusions. These preliminary results suggest a new role for chemotherapy in patients with advanced laryngeal cancer and indicate that a treatment strategy involving induction chemotherapy and definitive radiation therapy can be effective in preserving the larynx in a high percentage of patients, without compromising overall survival.