Treatment Outcomes for Synchronous or Metachronous Hypopharyngeal/Laryngeal/Oropharyngeal Cancer and Esophageal Cancer

同時或異時發生之口咽、咽喉或下咽癌及食道癌之治療結果

許哲瑜(Che-Yu Hsu) ； 成佳憲(Jason Chia-Hsien Cheng) ； 郭頌鑫(Sung-Hsin Kuo) ； 陳育瑄(Yu-Hsuan Chen) ； 蔡巧琳(Chiao-Ling Tsai) ； 藍耿學(Keng-Hsueh Lan) ； 陳婉渝(Wan-Yu Chen) ； 王駿瑋(Chun-Wei Wang)

《放射治療與腫瘤學》 19卷2期 (2012/06) Pp. 119-129

https://doi.org/10.6316/TRO/201219(2)119

摘要

目的：呈現頭頸部上皮癌（口咽、咽喉及下咽癌）伴隨同時或異時發生食道癌的病人，近十年來之治療經驗。材料及方法：本研究含1998至2008年，罹患同時或異時發生的口咽癌、咽喉或下咽癌及食道癌的病人。同時發生的定義為兩種腫瘤發生的時間在六個月內，異時發生的定義是兩種癌症發生的時間間隔大於六個月。在食道腫瘤的治療，有11位病人最終有接受手術切除 其餘22位病人則只接受放（化）療。在頭頸癌治療方面，有15個人接受手術切除，其餘18人只有接受放化療。結果：共33位病人收錄進本研究，其中10人罹患同時發生的癌症，其餘23人有異時發生的癌症。在本研究存活病人追蹤時間的中位數是41.3個月。所有病人存活時間及無疾病存活時間的中位數分別是13.6及9.3個月。在單變數分析中，對於存活時間與無疾病存活時間的良好預後因子為早期的食道癌。食道腫瘤的手術切除在預後方面有較佳的趨勢。結論：同時或異時發生的口咽癌、咽喉或下咽癌及食道癌常伴隨著不好的治療結果。發現時為早期之食道腫瘤能伴隨著較佳的預後。能以手術治療食道腫瘤的病人，在無疾病存活時間也有較佳的結果。

關鍵字

下咽 ； 口咽 ； 咽喉 ； 食道

並列摘要

Purpose: To evaluate the treatment of synchronous or metachronous hypopharyngeal / laryngeal / oropharyngeal head and neck cancer (H&N cancer) and esophageal cancer in our institution.Materials and Method: The retrospective study included patients with synchronous or metachronous H&N and esophageal cancer treated at our institution from 1998 to 2008. A synchronous malignancy was defined as a second malignancy diagnosed within 6 months after the initial diagnosis of cancer. A metachronous malignancy was defined as a second malignancy diagnosed more than 6 months after the initial diagnosis of cancer. For the treatment of esophageal cancer, 11 patients underwent surgery with or without neoadjuvant concurrent chemo-radiotherapy (CCRT), and the other 22 patients received definitive radiotherapy with or without concurrent chemotherapy. For the treatment of H&N cancer, 15 patients underwent surgical intervention with or without adjuvant CCRT, and the other 18 patients received definitive CCRT.Result: Our study included 33 patients. Among these patients, 10 presented with synchronous H&N and esophageal cancer, and 23 patients developed metachronous carcinomas. The median age at primary diagnosis was 56.8 years (range: 40.7-79.6 years). The median follow-up time for living patients was 41 .3 months. For the entire group, the median overall survival time (OS) and disease-free survival time (DFS) were 13.6 and 9.3 months, respectively. Univariate analysis revealed that T stage of esophageal cancer (T1/T2 vs. T3/T4) was a significant prognostic factor for OS and DFS (22.5 vs.12.2 months [p=0.041], and 21.3 vs. 8.5 months [p = 0.020], respectively). In the case of synchronous or metachronous esophageal cancer, surgical intervention was associated with a better outcome than radiotherapy, with borderline significance (p = 0.076).Conclusions: Patients with synchronous or metachronous H&N and esophageal cancer had poor outcomes. Those with T1/T2 esophageal cancer had a better chance for survival than those with T3/T4 esophageal cancer. This result implies that the T stage of esophageal cancer is a prognosis-limiting factor. Routine screening for synchronous or metachronous esophageal cancer may facilitate early detection and thereby improve the outcomes.

並列關鍵字

Hypopharynx ； Oropharynx ； Larynx ； Esophagus