局限性原發咽喉癌合併廣泛頸部淋巴轉移之治療

Treatment of Limited Primary Laryngeal and Pharyngeal Cancer with Extensive Cervical Metastasis

溫曉雯(Hsiao-Wen Wen) ； 王令瑋(Ling-Wei Wang) ； 李永賢(Wing-Yin Li) ； 朱本元(Pen-Yuan Chu)

《台灣耳鼻喉頭頸外科雜誌》 44卷1期 (2009/02) Pp. 9-15

https://doi.org/10.6286/2009.44.1.9

摘要

背景：晚期的頭頸部鱗狀上皮細胞癌，傳統上是以手術切除加上術後放射治療爲主，近年來在器官保留治療的趨勢下，先以放射治療或加上化學治療，再施以計畫性或救援性的手術。臨床上有時會遇到原發部位較小的咽喉癌，卻有廣泛的頸部淋巴轉移，以上述兩種方式治療都仍有其缺點。參考過去文獻，我們針對這類病患，先施以頸部淋巴廓清術，再施以放射治療，在不影響咽喉機能的前提下，亦對這類病人進行原發腫瘤切除，希望可以達到保留咽喉機能，並增加腫瘤的控制率。在此提出治療的結果。
方法：自1993年8月至2005年3月，共收集了13名咽喉癌病患（聲門上喉癌2例，口咽癌6例，下咽癌5例）皆符合早期原發腫瘤（T2以下）併廣泛頸部淋巴轉移（N2或N3且最大直徑超過3cm）。其中男性12例，女性1例。臨床腫瘤期別爲T1有5例，T2有8例，N2有11例，N3有2例。手術是以頸部淋巴廓清術爲主，有7例接受局限性的原發腫瘤切除（經口或直視喉鏡）。術後所有病患都接受放射治療。
結果：病理檢查結果N2a有2例，N2b有8例，N2c有1例，N3有2例，13例中有9例具淋巴結包膜外侵犯。手術後僅1例乳糜液滲漏之併發症，其餘病患傷口復原良好，所有病患都保留咽喉機能。平均追蹤時間爲67個月（22-162個月），有5例產生腫瘤復發：局部復發2例，對側頸部復發1例，遠端轉移2例；發生局部復發之2例在放療前均未接受原發腫瘤切除手術。所有局部或頸部復發者（共3例，包括局部復發2例，對側頸部復發1例），經救援性治療後，有2例腫瘤仍得到控制，3年之整體存活率爲76%，3年之疾病相關存活率爲85%。
結論：由我們的研究顯示，以頸部淋巴廓清術合併選擇性的原發腫瘤切除，再施以放射治療，來治療侷限性原發病灶併廣泛頸部淋巴轉移之咽喉癌病患，可達到理想的腫瘤控制率，又可保留咽喉機能。

關鍵字

咽喉癌 ； 頸部淋巴轉移 ； 頸部淋巴廓清術 ； 器官保留治療

並列摘要

BACKGROUND: The conventional treatment for advanced head and neck cancer has been radical surgery followed by postoperative radiotherapy. In recent years, chemoradiation followed by salvage or planned neck dissection has become increasingly popular. Both methods have had their limitations when the treated patients have small primary laryngeal or pharyngeal cancers with extensive cervical metastasis. For preserving laryngeal function and increasing tumor control rate, we performed neck dissection with or without limited primary tumor excision before radiotherapy for this kind of patients. This study shows the results of this treatment modality.
METHODS: From August 1993 to March 2005, 13 patients with small primary laryngeal and pharyngeal cancers (≦T2) with advanced cervical metastasis (N2 or N3, and the largest diameter＞3cm) were enrolled. Of these 13 patients, 2 had epiglottic cancers, 6 had oropharyngeal cancers and 5 had hypopharyngeal cancers. All patients received neck dissection with or without limited primary tumor excision followed by radiotherapy.
RESULTS: Of these 13 patients, 2 were with pN2a, 8 with pN2b, 1 with pN2c and 2 with pN3. Nine of 13 had extracapsular spreading. Only one patient had chylous leakage postoperatively and this resolved after conservative treatment. All patients preserved laryngeal function. The average follow-up period was 67 months (22-162 months). Five patients had recurrence: 2 had local recurrence, 1 had contralateral neck recurrence and 2 had distant metastasis. Two of the 3 with local or regional recurrence had good tumor control after salvage treatments. Three-year overall survival rate was 76%; 3-year disease-specific survival rate was 85%.
CONCLUSION: Neck dissection with or without limited primary tumor excision followed by radiotherapy has satisfactory oncologic and functional results for the treatment of small primary laryngeal or pharyngeal cancers with extensive cervical metastasis.

並列關鍵字

laryngeal and pharyngeal cancer ； cervical metastasis ； neck dissection ； organ preservation therapy