Salvage surgery after failure of very accelerated radiotherapy in advanced head-and-neck squamous cell carcinoma
Salvage surgery after failure of very accelerated radiotherapy in advanced head-and-neck squamous cell carcinoma
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DOI：
10.1016/j.ijrobp.2004.12.062
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发表时间：
2005-07-15
影响因子：
7
通讯作者：
Bourhis, J
中科院分区：
文献类型：
--
作者：
Temam, S;Pape, E;Bourhis, J
目的：评估局部晚期头颈鳞状细胞癌 (HNSCC) 加速放疗后局部或颈部淋巴结复发的挽救手术的疗效和毒性。方法和材料：我们回顾了 136 名 HNSCC 患者的病历，这些患者在古斯塔夫-鲁西研究所连续三项临床试验中使用极加速放疗方案（62 至 64 Gy，每日 2 次 1.8 至 2 剂量）进行治疗。 3.5 周以上）。 136 名初始患者中的 69 名患者 (51%) 出现局部或颈部淋巴结复发，或两者兼而有之。 结果：这 69 名患者中有 16 名 (23%) 因局部复发 (n = 8) 或颈部淋巴结复发 (n = 8) 接受了挽救手术。所有 16 名患者最初均被诊断为局部晚期口咽癌（T4，11 名患者；T3，5 名患者），其中 13 名患者最初有颈淋巴结受累。抢救手术后，6例患者出现局部复发； 7、颈淋巴结复发； 3、远处转移。因此，只有 3 名患者的挽救手术取得了成功。 3 年和 5 年总体精算生存率分别为 20% 和 11%。 8 例患者出现严重的术后伤口并发症，其中 3 例发生颈动脉破裂。结论：晚期 HNSCC 极加速放疗后复发的挽救手术不太可行，且生存获益有限。它应该只在仔细选择的情况下使用。 (c) 2005 年爱思唯尔公司。
Purpose: To assess the efficacy and toxicity of salvage surgery for local or cervical nodal recurrence after accelerated radiotherapy for locally advanced head-and-neck squamous cell carcinoma (HNSCC).Methods and Materials: We reviewed the medical records of the 136 patients with HNSCC who had been treated in three consecutive clinical trials at the Institut Gustave-Roussy using a very accelerated radiotherapy regimen (62 to 64 Gy with 2 daily fractions of 1.8 to 2 Gy over 3.5 weeks). Sixty-nine patients of the 136 initial patients (51%) had local or neck lymph nodes relapse, or both.Results: Sixteen of these 69 patients (23%) had undergone salvage surgery for recurrence locally (n = 8) or in the cervical nodes (n = 8). All 16 had initially been diagnosed with locally advanced oropharyngeal carcinoma (T4, 11 patients; T3, 5 patients), and 13 had initially had cervical node involvement. After salvage surgery, 6 patients had had a local recurrence; 7, cervical node recurrence; and 3, distant metastasis. Thus, salvage surgery had been successful only in 3 patients. The 3- and 5-year overall actuarial survival rates were 20% and 11%, respectively. Eight patients had major postoperative wound complications, including carotid rupture in three cases.Conclusion: Salvage surgery for relapse after very accelerated radiotherapy for advanced HNSCC is infrequently feasible and is of limited survival benefit. It should be used only in carefully selected cases. (c) 2005 Elsevier Inc.