Treatment Results of Hypopharyngeal Cancer based

下咽癌之放射治療結果與預後因子分析

Pang-Yu Chen ； Shih-Neng Yang ； Ji-An Liang ； Ming-Hsui Tsai

《放射治療與腫瘤學》 14卷2期 (2007/06) Pp. 63-73

https://doi.org/10.6316/TRO/200714(2)63

摘要

目的：分析一至四期下咽癌病人接受聲帶保留放射治療之治療結果與預後因子。
材料與方法：自 1996 年 1 月至 2005 年 6 月，共有 130 位一至四期之下咽癌病人完成聲帶保留放射治療，其中 126 位病患的腫瘤源發部位為梨狀竇。放射治療劑量為每日 1.8 Gy，總劑量從68.4 至 82.4 Gy（中位值 70.2 Gy），98 位病患接受 cisplatin 合併 5-fluorouracil 的化學治療。分析這些病人之臨床資料後，以 Kaplan-Meier 方式計算五年之整體存活率、疾病有關存活率、及局部腫瘤控制率，並以 Cox’s proportional hazards model 進行多變數分析尋找預後有關因子。
結果：治療後的追蹤時間中位數是 39 個月（範圍從14至120個月）。第一二期，三期，四期的病患的五年整體存活率及疾病有關存活率分別為 56%/64%，30%/43%，及 14%/15%。而所有病人，第一二期，三期，四期病患之五年腫瘤局部控制率分別為 34%，66%，46%，18%（p 值為0.004）。多變數分析結果顯示第四期的腫瘤為導致局部復發的預後因子（p 值為 0.002）。
結論：第一二期之下咽癌病人適合接受聲帶保留放射治療，至於第三期病人因半數發生局部復發，所以聲帶保留治療方式的角色仍有待進一步研究。此外第四期之病患以同樣治療方式之預後較差，應合併更積極的治療策略。

並列摘要

Purpose : To investigate the prognostic factors for survival and locoregional control in patients with stage I-IV hypopharyngeal cancer (HPC) treated with curative-intent laryngeal preservation radiotherapy (LPRT).
Materials and Methods : From January 1996 through June 2005, 130 patients with stage I-IV squamous cell carcinoma of the hypopharynx were enrolled in this retrospective analysis. The pyriform sinus was the principle site of involvement in 126
cases. All patients received 1.8 Gy daily up to a total dose of 68.4 to 82.4 Gy (median 70.2 Gy). Ninety-eight patients (75.4%) received chemotherapy combined with cisplatin plus 5-fluorouracil (5-FU). Actuarial survival (AS), disease-specific survival (DSS) and local relapse-free survival (LRFS) were calculated, and multivariate analyses were performed using the Cox’s proportional hazards model.
Results : With a median follow-up duration of 39 months (range 14 to 120 months), the 5-year AS/DSS was 56%/64% for patients with stage I-II disease, 30%/43% for stage III disease, and 14%/15% for those with stage IV disease. The 5-year LRFS rate was 34% for all patients, 66% for patients with stage I-II disease, 46% for stage III disease, and 18% for those with stage IV disease (p = 0.004). Multivariate analyses showed that stage
IV disease was an independent prognostic factor for local recurrence (p = 0.002).
Conclusions : Patients with stage I-II disease are suitable for LPRT. Indiscriminate use of LPRT for stage III disease is still problematic because nearly half of these patients had
unsuccessful outcomes. For most patients with stage IV, the treatment results were poor.
More aggressive combined modality treatment should be considered.