Treatment of Advanced Hypopharyngeal Cancer-Comparison of Two Modalities

晚期下咽癌的治療－二種模式的比較

洪世凱(Shih-Kai Hung) ； 陳泓里(Hung-Li Chen) ； 謝忱希(Chen-His Hsieh) ； 許文林(Wen-Lin Hsu) ； 張國華(Kuo-Hwa Chang) ； 劉岱瑋(Dai-Wei Liu) ； 陳裕仁(Yuen-Jen Chen) ； 李文星(Moon-Sing Lee)

《慈濟醫學雜誌》 18卷1期 (2006/02) Pp. 15-21

https://doi.org/10.6440/TZUCMJ.200602.0012

並列摘要

Objective: The purpose of this retrospective study is to compare the results of treatment of locally advanced hypopharyngeal carcinoma with two different protocols. Patients and Methods: From December 1999 to December 2004, the records of 60 patients with locally advanced (stage Ⅲ/Ⅳ) hypopharyngeal cancer treated at a number of centers were reviewed. Thirty-eight patients had been treated with definitive concurrent chemoradiation (CCRT) followed by adjuvant systemic chemotherapy, and 22 patients with surgery plus postoperative CCRT followed by adjuvant systemic chemotherapy (SCCRT). Surgical procedures consisted of total laryngectomy with partial or total pharyngectomy and esophagectomy as indicated. CCRT consisted of weekly cisplatin 30 mg/m^2 plus radiotherapy in a dose of 66 to 70.2 Gy for the CCRT group and 60 to 66 Gy for SCCRT group. Each group had systemic adjuvant chemotherapy with four monthly cycles of cisplatin 20 mg/m^2 and 5-fluorouracil 1000 mg/m^2 for five consecutive days. The study end points included outcome and toxicity. Various clinical factors were assessed as prognostic indicators. Results: There was no significant difference in T and N status between the two treatment groups, nor were there significant differences in overall or disease-free survival, local control or the incidence of distant metastasis (p＞0.05). In the CCRT group, the mean survival was 24.0 months, with an estimated 3-year overall survival of 38%. Local regional failure occurred in 68% and distant metastasis in 24%. Radiation doses ＞70 Gy yielded significantly better survival and local control than doses ＜70 (p＜0.05). Ten patients (26%) retained their larynx for more than two years. In the SCCRT group, the estimated 3-year overall survival was 43%. Local regional failure occurred in 68% and distant metastasis in 33%. In patients treated with SCCRT, multivariate analysis showed that perineural invasion and necrosis were significant predictors of overall survival. Conclusions: While CCRT and SCCRT yielded similar survival, CCRT resulted in a higher incidence of organ preservation. We therefore may suggest that CCRT is an effective definitive treatment for patients with advanced hypopharyngeal carcinoma. In order to achieve acceptable local control rates and survival, a high dose of radiation (＞70 Gy) should be given.

並列關鍵字

hypopharyngeal carcinoma ； concurrent chemoradiation ； surgery