晚期下咽癌之治療經驗

Treatment of Advanced Hypopharyngeal Cancer

徐莉萍(Lee-Ping Hsu) ； 陳培榕(Peir-Rong Chen)

《中華民國耳鼻喉科醫學雜誌》 36卷6期 (2001/10) Pp. 353-359

https://doi.org/10.6286/2001.36.6.353

摘要

背景：晚期下咽癌的預後一直是頭頸部癌症中最差的，較常被使用的治療方式是以手術廣泛切除、加上術後放射治療，但患者接受度低。近來以化學療法合併放射治療，以期保留患部器官的方式，於下咽癌的治療結果仍有爭議。本研究藉由病例回溯分析，針對晚期之下咽癌，依不同治療方式加以比較，以期提出較合適的治療建議。
方法：自1991年至1999年間，診斷為下咽癌、落籍花東地區，分期屬晚期（stage III/IV）的下咽癌病人，累計共93例，分別接受：手術加術後放射或合併化學治療、先頸部手術再接受化療合併放射治療、化療合併放射治療、僅接受放射治療、及無積極治療等5種不同的處置。
結果：本研究晚期下研究癌整體的5年存活率約22%。比較各組之疾病控制情形、預後、死亡原因後發現：第1組的原發部位控制、存活率最好，其失敗的主要原因為遠隔轉移（33%）。其他原發部位非以手術切除的治療方式，存活率明顯較差，失敗的最大原因皆為原發部位控制不佳，有殘存腫瘤或復發的比例超過50%，且其中1/3的病人會因咽喉腫瘤大出血而猝死。頸部先手術組的局部控制率不如預期。化療合併放射治療的成績、與只用放射治療無差別，且併發症較大。
結論：手術廣泛切除加術後放射或合併化學治療，仍是目前最好的治療建議。

關鍵字

晚期下咽癌 ； 咽喉切除術 ； 化療合併放射治療

並列摘要

BACKGROUND: Survival rates for patients with hypopharyngeal cancer are the poorest among head and neck cancers. The standard treatment for locally advanced hypopharyngeal cancer, surgery plus postoperative radiotherapy (RT), is usually debilitating and unacceptable. To improve the treatment results, alternative approaches such as combining RT and chemotherapy (CT) have been investigated. The purpose of this study was to retrospectively analyze our experience with different modalities to inform future approaches to the treatment of advanced hypopharyngeal cancer.
METHODS: Between January 1991 and October 1999, 93 patients with advanced hypopharyngeal cancer (stage III/IV) in the Hualien and Taitung areas were enrolled. Based on the different treatment regimens, the subjects were divided into five groups: surgery with postoperative RT or concurrent chemoradiotherapy (CCRT), neck dissection prior to definitive CCRT, CCRT, RT only, and palliative treatment. Survival rates for each group were calculated and compared.
RESULTS: The projected overall 5-year survival was 22%. The first group had the best local control rate and survival, although failures at distant sties were high (33%). Poor local control rates (＜50%) were noticed in patients with laryngeal preservation, with one third experiencing sudden death from massive tumor hemorrhages. The survival rate for patients with laryngeal preservation was significantly lower than that of the pharyngolaryngectomy group. Outcomes for neck dissection prior to CCRT group were disappointing. The CCRT group had more life-threatening complications than the RT group although survival was about the same for both groups.
CONCLUSIONS: Of the approaches analyzed, surgery followed by postoperative RT or CCRT is the most appropriate modality for the treatment of advanced hypopharyngeal cancer.

並列關鍵字

advanced hypopharyngeal cancer ； pharyngolaryngectomy ； concurrent chemoradiotherapy