挽救性手術後再次輔助性放射治療於復發性頭頸部鱗狀上皮細胞癌患者之適用性

The Applicability of Adjuvant Reirradiation for Patients with Recurrence of Previously Irradiated Head and Neck Squamous Cell Carcinoma after Salvage Surgery

張明璋(Ming-Chang Chang) ； 林士捷(Shih-Chieh Lin) ； 花俊宏(Chun-Hung Hua) ； 蔡銘修(Ming-Hsui Tsai)

《台灣耳鼻喉頭頸外科雜誌》 47卷1期 (2012/02) Pp. 32-41

https://doi.org/10.6286/2012.47.1.32

摘要

背景：復發性頭頸部鱗狀上皮細胞癌經挽救性手術後仍有高度復發機率，再次輔助性放射治療或許能爭取較高腫瘤控制機會，但考量放射治療有劑量極限及可能伴隨併發症而仍有所爭議，本研究即採討其適用性。方法：採回溯性病歷分析，收集2000至2009年於本院治療之頭頸部鱗狀上皮細胞癌患者，先前已經過放射治療而後有復發並接受挽救性手術，分析病理發現及有無接受再次輔助性放射或放射化學治療與治療結果之相關性，來探討其適用性。結果：共收集患者觀察長且48人次，再次放射治療組22人次，使用費雪精確檢定及威爾克森排序檢定分析相關危險因子。觀察組中，神經周圍侵犯、淋巴血管侵犯、腫瘤分期T3以上、淋巴被膜外擴散及危險因子總數與腫瘤控制失敗有顯著相關。再次放射治療組中，所有因子皆與治療失敗無顯著相關，兩年疾病控制率為18.1%，有合併化學治療者兩年整體存活率（60％）顯著較單獨再次放射治療（12.5％）為高。結論：挽救性手術之病理危險因子與初次手術一般具有預測微觀殘留癌細胞能力，且具加成效果，若無接受術後輔助治療其復發機會較高。由於單獨放射治療效果有限，若無法接受最大劑量放射化學治療，保守觀察為建議選項。（台耳醫誌 2012; 47:32-41）

關鍵字

頭頸癌復發 ； 手術後再次放射治療 ； 放射化學治療 ； 強度調控放射治療

並列摘要

BACKGROUND: The results of salvage surgery alone for the recurrence of previously irradiated head and neck squamous cell carcinoma (HNSCC) remain poor due to the high rate of locoregional failures. Postoperative reirradiation may provide a better disease control rate, but possible toxicity caused by a high accumulative radiation dose makes its application controversial. Hence, we investigated the applicability of postoperative reirradiation in this study.MATERIALS AND METHODS: We reviewed institutional electronic records of patients with recurrent HNSCC in a previously irradiated area after they underwent surgery between 2000 and 2009. The relationships among pathological risk factors, treatment with or without postoperative reirradiation/chemoradiation, and disease control were analyzed to delineate the applicability of post-operative adjuvant reirradiation.RESULTS: We included 48 and 22 events in the observation group and reirradiation group, respectively. In the observation group, perineural invasion, lymphovascular permeation, tumor stage above T3, extracapsular spread, and the sum of risk factor numbers influenced the treatment results significantly, as proved by Fisher's exact test and Wilcoxon rank sum test. On the contrary, none of the risk factors in the reirradiation group was related to treatment outcome. The 2-year overall disease control rate in the reirradiation group was 18.1%, and 2-year overall survival was significantly higher in patients treated with full-dose concurrent chemoradiotherapy (CCRT) than reirradiation alone (60% vs. 12.5%, log-rank test p = 0.02).CONCLUSION: The pathological risk factors of salvage surgery are as useful as those of primary surgery in predicting microscopic residual cancer cells. If postoperative adjuvant therapy is not applied, more risk factors are detected, and there is a higher risk of locoregional failures. Postoperative full-dose chemoradiation, if affordable, is suggested for patients with a high risk of recurrence. However, if not affordable, close observation is considered since the disease control rate of postoperative reirradiation alone is limited. (J Taiwan Otolaryngol Head Neck Surg 2012; 47:32-41)

並列關鍵字

recurrent head and neck cancer ； postoperative reirradiation ； chemoradiotherapy ； IMRT