Neck dissection in the combined-modality therapy of patients with locoregionally advanced head and neck cancer
Neck dissection in the combined-modality therapy of patients with locoregionally advanced head and neck cancer
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DOI：
10.1002/hed.10394
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发表时间：
2004-05-01
影响因子：
2.9
通讯作者：
Vokes, EE
中科院分区：
文献类型：
--
作者：
Argiris, A;Stenson, KM;Vokes, EE
目的.本研究旨在探讨颈淋巴结（ND）在局部晚期头颈癌联合清扫治疗中的作用。我们确定了N2-N3头颈部癌症患者，这些患者入组了3项连续的多中心11期同步放化疗研究，采用5-氟尿嘧啶和羟基脲，每周一次，每天两次放疗加顺铂（C-FHX）或紫杉醇（T-FHX）。排除原发灶不明、鼻咽或副鼻窦原发灶、非鳞状组织学、治疗期间进展或死亡、或治疗不完全的患者。共分析了131例患者。N2期占79%。92例患者（70%）在入组前（n = 31）或放化疗后（n = 61）进行了ND。中位随访时间为4.6年，ND患者的5年局部和颈部无进展生存期（PFS）率高于无ND患者：分别为88%和74%（p =.02）以及99%和82%（p =.0007）; ND患者的总生存期（OS）也有改善的趋势，但PFS和远处PFS相当。在N3疾病患者亚组中，ND不仅与更好的局部区域控制相关，而且与远端PFS改善相关。然而，在临床完全缓解的患者中（n = 92），PFS（5年时68% vs 75%，p = 0.53）或任何其他生存参数（伴或不伴ND）无显著差异。ND改善了颈部控制，是临床残留疾病或N3颈部癌症患者所需的，但对N2期疾病患者的结局无显著影响，这些患者在强化同步放化疗后临床无病。(C)2004 Wiley Periodicals，Inc.
Purpose. The purpose of this study was to evaluate the role of neck lymph node (ND) in the combined dissection modality therapy for locoregionally advanced head and neck cancer.Methods. We identified patients with N2-N3 head and neck cancers who were enrolled in three consecutive multicenter phase 11 studies of concurrent chemoradiotherapy utilizing 5-fluorouracil and hydroxyurea on an alternate-week schedule with radiotherapy twice daily plus either cisplatin (C-FHX) or paclitaxel (T-FHX). Patients with unknown primary tumors, nasopharyngeal or paranasal sinus primaries, nonsquamous histology, progression or death during therapy, or incomplete therapy were excluded.Results. A total of 131 patients were analyzed. Seventy-nine percent had N2 stage. ND was performed in 92 patients (70%), either prior to enrollment (n = 31) or after chemoradiotherapy (n = 61). With a median follow-up of 4.6 years, the 5-year locoregional and neck progression-free survival (PFS) rates were higher in patients with ND versus patients without ND: 88% versus 74% (p =.02) and 99% versus 82% (p =.0007), respectively; there was also a trend toward improved overall survival (OS) with ND, but PFS and distant PFS were comparable. In the subset of patients with N3 disease, ND was associated not only with better locoregional control but also with improved distant PFS. However, in patients with clinical complete response (n = 92), no significant differences in PFS (68% vs 75% at 5 years, p =.53) or any other survival parameters with or without ND were observed.Conclusions. ND improves neck control and is required for patients with clinically residual disease or N3 neck cancer but has no significant impact on the outcome of patients with N2 stage disease who are rendered clinically disease-free with intensive concurrent chemoradiotherapy. (C) 2004 Wiley Periodicals, Inc.