Elderly Oropharynx-Hypopharynx Carcinoma Patients: Induction Chemotherapy Plus Chemoradiotherapy Improve Cancer Controls Than Radiotherapy Alone

年長族群口咽及下咽癌：前導性化療合併同步化放療比單獨放射治療更能增進腫瘤控制

張耀文(Yao-Wen Chang) ； 李文星(Moon-Sing Lee) ； 洪世凱(Shih-Kai Hung) ； 邱文彥(Wen-Yen Chiou) ； 許文林(Wen-Lin Hsu) ； 劉岱瑋(Dai-Wei Liu) ； 蘇裕傑(Yu-Chieh Su) ； 黃經民(Jing-Min Hwang) ； 李思錦(Szu-Chi Li) ； 林宏益(Hon-Yi Lin)

《放射治療與腫瘤學》 18卷3期 (2011/09) Pp. 181-192

https://doi.org/10.6316/TRO/201118(3)181

摘要

背景：本篇研究老年口咽及下咽癌族群（以治癒為抗癌目的並且沒有接受手術的病人）：探討前導性化療合併同步化放療與單獨接受放射治療之效果比較。方法：我們回溯收集2003至2007年，組織學證實為口咽或下咽癌，年紀超過70歲並且沒接受手術的病人44位。病人分為兩組，A組（前導性化療加上同步化放療，n=22）和B組（只做放射治療，n=22）。依病人的腫瘤位置，性別及臨床分期在兩組中使用一對一(1:1)配對分析。總共有三十六位男性及八位女性案例，年齡中位數為76歲（分佈範圍為70~88歲）。實驗的觀察標的(end point)為病人的存活率及腫瘤控制。結果：所有病人追蹤的時間中位數為35個月（分佈範圍為1~72個月）。在第三年，A組呈現比B組更好的腫瘤控制，在局部區域控制率（86.4%比36.4%，p=0.002）及無病生存率（61.4%比36.4%，p=0.035）。然而，在疾病特異生存率及總生存率上，兩組沒有顯著差異。可以想見的是，A組比B組有更多的治療副作用（Grade 3~4的黏膜炎，63.6%比27.3%，p=0.015）。結論：對沒有接受手術的老年口咽下咽癌患者來說，前導性化療合併同步化放療比起只做放射治療，明顯增進腫瘤控制率，只做放射治療應該只適合臨床上不適合做化療的病人。

關鍵字

口咽癌 ； 下咽癌 ； 放射治療 ； 化學治療 ； 年長

並列摘要

Methods: Between 2003 and 2007, we retrospectively included 44 histologically proven oropharynx-hypopharynx carcinoma patients who were aged more than 70 years and treated non-surgically. Two groups were defined: the group A (induction chemotherapy plus CCRT, n=22) and the group B (RT alone, n=22). Patients in the group B were 1:1 match-paired to those in the group A by using three factors: cancer subsite, gender, and clinical stage. Totally, there were 36 males and 8 females, with a median age of 76 years (range, 70-88 years). Patient survival and cancer control were defined as study end points.Background: This study intended to compare treatment results between induction chemotherapy plus chemoradiotherapy (CCRT) and radiotherapy (RT) alone in elderly oropharynx-hypopharynx carcinoma patients who were treated curatively and non-surgically.Results: The median follow-up time for all patients was 35.0 months (range, 1-72 months). At 3 years, the group A demonstrated better cancer controls than the group B, in terms of locoregional control (86.4% versus 36.4%, p=0.002) and disease-free survival (61.4% versus 36.4%, p=0.035). However, no statistically significant differences were found on disease-specific and overall survivals. Not surprisingly, more treatment-related toxicity were observed in the group A than in the group B (grade 3-4 mucositis, 63.6% versus 27.3%, p=0.015).Conclusions: For elderly oropharynx-hypopharynx carcinoma patients treated nonsurgically, induction chemotherapy plus CCRT significantly improves cancer control when compared with RT alone. RT alone should be reserved for patients who are medically contra-indicated to chemotherapy.

並列關鍵字

Oropharynx carcinoma ； Hypopharynx carcinoma ； Radiotherapy ； Chemotherapy ； Elderly