Chemoselection as a strategy for organ preservation in patients with T4 laryngeal squamous cell carcinoma with cartilage invasion.
Chemoselection as a strategy for organ preservation in patients with T4 laryngeal squamous cell carcinoma with cartilage invasion.
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化学选择作为 T4 喉鳞状细胞癌伴软骨侵犯患者器官保存的策略。
DOI：
10.1002/lary.20294
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发表时间：
2009
期刊：
影响因子：
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通讯作者：
Tsie
中科院分区：
文献类型：
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作者：
Worden,FrancisP;Moyer,Jeffrey;Lee,JuliaS;Taylor,JeremyMG;Urba,SusanG;Eisbruch,Avraham;Teknos,TheodorosN;Chepeha,DouglasB;Prince,MarkE;Hogikyan,Norman;Lassig,AmyAnneD;Emerick,Kevin;Mukherji,Suresh;Hadjiski,Lubomir;Tsie
目的/假设在III/IV期喉鳞状细胞癌（SCC）患者的两项连续II期临床试验中，获得了较高的总生存率（OS）和喉保留率。患者在对一个周期的新辅助化疗（IC）的原发性肿瘤反应>50%后接受放化疗治疗。我们分析了结果为T4患者与软骨invasion from both study.Study DesignRetrospective.MethodsRecords从36例T4喉鳞状细胞癌与软骨入侵单独（n = 16）或软骨入侵和喉外蔓延（n = 20）进行了回顾性分析。所有患者均接受一个周期的顺铂（100 mg/m2）[或卡铂（AUC 6）]和5-氟尿嘧啶（1，000 mg/m2/d，持续5天）（P+5 FU）治疗。在原发性肿瘤达到>50%反应的患者接受放化疗（70戈伊; 35次分次，同时顺铂-100 mg/m2[卡铂（AUC 6）]，每21天一次，共3个周期），随后辅助P+5 FU治疗完全组织学反应者（CR）。IC后反应<50%的患者接受全喉切除术和术后放疗。Results 36例患者中有29例（81%）IC后反应>50%。其中27例接受了明确的放化疗，23例（85%）获得了保留喉功能，保留喉功能率为58%。3年OS为78%，疾病特异性生存率为80%（中位随访时间为69个月）。放化疗后，8/11（73%）的患者与一个完整的喉有>75%的可理解的语言，6/36（17%）是G管依赖和6/36（17%）是气管造口术dependent.ConclusionsOur结果表明，化疗选择是一个可行的器官保存替代全喉切除术的患者与T4喉鳞状细胞癌软骨入侵。喉镜，2009年
Objectives/HypothesisHigh rates of overall survival (OS) and laryngeal preservation were achieved in two sequential phase II clinical trials in patients with stage III/IV laryngeal squamous cell carcinoma (SCC). Patients were treated with chemoradiation after a >50% primary tumor response to one cycle of neoadjuvant chemotherapy (IC). We analyzed outcomes for T4 patients with cartilage invasion from both studies.Study DesignRetrospective.MethodsRecords from 36 patients with T4 SCC of the larynx with cartilage invasion alone (n = 16) or cartilage invasion and extralaryngeal spread (n = 20) were retrospectively reviewed. All were treated with one cycle of cisplatin (100 mg/m2) [or carboplatin (AUC 6)] and 5‐fluorouracil (1,000 mg/m2/d for 5 days) (P+5FU). Those achieving >50% response at the primary tumor received chemoradiation (70 Gy; 35 fractions with concurrent cisplatin‐100 mg/m2[carboplatin (AUC 6)] every 21 days for 3 cycles), followed by adjuvant P+5FU for complete histologic responders (CHR). Patients with <50% response after IC underwent total laryngectomy and postoperative radiation.ResultsTwenty‐nine of 36 patients (81%) had >50% response following IC. Of these, 27 received definitive chemoradiation, 23 (85%) obtained CHR, with 58% laryngeal preservation rate. The 3‐year OS was 78%, and the disease‐specific survival was 80% (median follow‐up 69 months). Following chemoradiation, 8/11 (73%) patients with an intact larynx had >75% understandable speech, 6/36 (17%) were g‐tube dependent and 6/36 (17%) were tracheostomy dependent.ConclusionsOur results suggest that chemo‐selection is a feasible organ preservation alternative to total laryngectomy for patients with T4 laryngeal SCC with cartilage invasion. Laryngoscope, 2009