Squamous cell carcinoma of the oropharynx - Surgery, radiation therapy, or both
Squamous cell carcinoma of the oropharynx - Surgery, radiation therapy, or both
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DOI：
10.1002/cncr.10567
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发表时间：
2002-06-01
期刊：
影响因子：
6.2
通讯作者：
Million, RR
中科院分区：
文献类型：
--
作者：
Parsons, JT;Mendenhall, WM;Million, RR
背景：口咽部鳞状细胞癌（SCC）患者的治疗仍存在争议。没有一项随机试验能够充分说明手术、放射治疗或联合治疗是否最有效。通过MEDLINE检索（从1970年到2000年8月）和每篇报告中引用的参考文献，对来自北美学术机构的扁桃体区域或舌根SCC患者使用S加或不加辅助RT（S RT）或单独使用RT或随后进行颈清扫术（RT +/- ND）的治疗结果进行了汇编。如果研究包含以下终点的直接、精算（生命表）或Kaplan-Meier计算，则符合入选条件：局部控制、局部区域控制、5年绝对生存期、5年病因特异性生存期或重度或致死性治疗并发症。为了治疗比较的目的，计算每个终点的加权平均结果，其中考虑了系列大小。结果和结论基于51个报告系列的数据，代表了来自美国和加拿大的约6400例患者的治疗。舌根部鳞状细胞癌患者分别接受S +/- RT和RT +/- ND的结果如下：局部对照，79%对76%，（P = 0.087）;局部-区域对照，60% vs 69%（P = 0.009）; 5年生存率，49% vs 52%（P = 0.2）; 5年病因特异性生存率，62% vs 63%严重并发症发生率分别为32%和3.8%（P < 0.001），致死性并发症发生率分别为3.5%和0.4%（P < 0.001）。扁桃体区域SCC患者分别接受S +/- RT和RT +/- ND的结果如下：局部对照，70%对68%，（P = 0.2）;局部-区域控制，65% vs 69%（P = 0.1）; 5年生存率，47% vs 43%（P = 0.2）; 5年病因特异性生存率，57% vs 59%严重并发症发生率分别为23%和6%（P < 0.001），致死性并发症发生率分别为3.2%和0.8%（P < 0.001）。美国文章中的信息为口咽SCC患者的循证咨询提供了有用的基准。接受S RT或RT ND的患者的局部控制率、局部区域控制率、5年生存率和5年特定原因生存率相似，而S RT组的严重或致命并发症发生率显着更高。此外，关于治疗的功能后果的现有数据表明RT ND的优越性。作者得出结论，RT ND对于大多数口咽癌SCC患者是优选的。2002;94：2967-80. (C)2002年美国癌症协会。
BACKGROUND, The treatment of patients with squamous cell carcinoma (SCC) of the oropharynx remains controversial. No randomized trial has addressed adequately the question of whether surgery (S), radiation therapy (RT), or combined treatment is most effective.METHODS. Treatment results from North American academic institutions that used S with or without adjuvant RT (S RT) or used RT alone or followed by neck dissection (RT +/- ND) for patients with SCC of the tonsillar region or the base of tongue were compiled through a MEDLINE search (from 1970 to August, 2000) and from the references cited in each report. Studies were eligible for inclusion if they contained direct, actuarial (life-table), or Kaplan-Meier calculations for the following end points: local control, local-regional control, 5-year absolute survival, 5-year cause specific survival, or severe or fatal treatment complications. Weighted average results, which took into account series size, were calculated for each end point for the purposes of treatment comparison. Results and conclusions were based on data from 51 reported series, representing the treatment of approximately 6400 patients from the United States and Canada.RESULTS. The results for patients with SCC of the base of tongue who underwent S +/- RT versus RT +/- ND, respectively, were as follows: local control, 79% versus 76% (P = 0.087); local-regional control, 60% versus 69% (P = 0.009); 5-year survival, 49% versus 52% (P = 0.2); 5-year cause specific survival, 62% versus 63% (P = 0.4); severe complications, 32% versus 3.8% (P < 0.001); and fatal complications, 3.5% versus 0.4% (P < 0.001). The results for patients with SCC in the tonsillar region who underwent S +/- RT versus RT +/- ND, respectively, were as follows: local control, 70% versus 68% (P = 0.2); local-regional control, 65% versus 69% (P = 0.1); 5-year survival, 47% versus 43% (P = 0.2); 5-year cause specific survival, 57% versus 59% (P = 0.3); severe complications, 23% versus 6% (P < 0.001); and fatal complications, 3.2% versus 0.8% (P < 0.001).CONCLUSIONS. The information in Us article provides a useful benchmark for evidence-based counseling of patients with SCC of the oropharynx The rates of local control, local-regional control, 5-year survival, and 5-year cause specific survival were similar for patients who underwent S RT or RT ND, whereas the rates of severe or fatal complications were significantly greater for the S RT group. Furthermore, available data on the functional consequences of treatment suggest the superiority of RT ND. The authors conclude that RT ND is preferable for the majority of patients with SCC of the oropharynx Cancer. 2002;94:2967-80. (C) 2002 American Cancer Society.