Effectiveness of superselective and selective neck dissection for advanced nodal metastases after chemoradiation.
Effectiveness of superselective and selective neck dissection for advanced nodal metastases after chemoradiation.
复制标题
超选择性和选择性颈清扫术对放化疗后晚期淋巴结转移的有效性。
DOI：
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发表时间：
2005
期刊：
影响因子：
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通讯作者：
F. Vieira
中科院分区：
文献类型：
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作者：
K. Robbins;I. Doweck;S. Samant;F. Vieira
客观化
目的探讨选择性和超选择性颈淋巴清扫术联合动脉内化疗和放疗治疗巨大或残留淋巴结转移瘤的疗效。
设计
前瞻性研究。
设置
田纳西大学孟菲斯分校。
病人
共有240名头颈部鳞状细胞癌III或IV期患者。
干预措施
治疗方案：顺铂150 mg/m2动脉内注射，硫代硫酸钠9g/m2静脉滴注，每周1次，共4周；放射治疗，每日2次，每周5次，共68~74Gy6~7周。
主要结果衡量标准
接受根治性或改良根治性颈清扫术(n=12)、选择性颈清扫术(n=65)和超选择性颈清扫术(仅II-III级)(n=7)的患者的区域控制、远处转移和总存活率。
结果
在240例患者中，对84例有巨大结节病变的患者进行了106次颈清扫术。平均随访58个月(12~96个月)，240例患者中有11例(4.6%)发生局部失败：改良根治性颈清扫术12例中2例(17%)，选择性颈清扫术65例中3例(5%)，超选择性颈清扫术7例中无一例，未行颈清扫术156例中6例(4%)。总生存率和远处转移率在3种颈清扫术亚组间无显著差异。
结论
选择性和超选择性颈淋巴清扫术保留了功能，将发病率降至最低，对于动脉内放化疗后残留病变限制在1级的患者是可行的治疗选择，也可能用于其他放化疗方案。
OBJECTIVE
To determine the efficacy of selective and superselective neck dissection for patients with bulky or residual nodal metastasis treated with concomitant intra-arterial cisplatin and radiotherapy.
DESIGN
Prospective study.
SETTING
University of Tennessee, Memphis.
PATIENTS
A total of 240 patients with stage III or IV head and neck squamous cell carcinoma.
INTERVENTIONS
Treatment with cisplatin, 150 mg/m2 intra-arterially, and sodium thiosulfate, 9 g/m2 intravenously, weekly for 4 weeks; and radiotherapy, 2 Gy per fraction per day, 5 times weekly, for a total of 68 to 74 Gy over 6 to 7 weeks.
MAIN OUTCOME MEASURES
Regional control, distant metastases, and overall survival for patients undergoing radical or modified radical neck dissection (n = 12), selective neck dissection (n = 65), and superselective neck dissection (levels II-III only) (n = 7).
RESULTS
Among the total group of 240 patients, 106 neck dissections were performed on 84 patients who had bulky nodal disease. With a median follow-up of 58 months (range, 12-96 months), regional failure occurred in 11 (4.6%) of 240 patients: 2 (17%) of the 12 who had modified radical neck dissection, 3 (5%) of the 65 who had selective neck dissection, none of the 7 patients who had superselective neck dissection, and 6 (4%) of the 156 who had no neck dissection. The rates of overall survival and distant metastases were not significantly different among the 3 neck dissection subsets.
CONCLUSION
Selective and superselective neck dissection, which spare function and minimize morbidity, are viable therapeutic alternatives for patients with residual disease confined to 1 level after intra-arterial chemoradiation treatment, and possibly for other chemoradiation protocols.