- 期刊
Efficacy of Salvage Neck Dissection for Cervical Recurrent Nasopharyngeal Carcinoma
鼻咽癌放射線治療後頸部復發的手術治療
摘要
背景：原發性鼻咽癌目前治療的主流是放射線治療，然而對於放射線治療後頸部復發的患者則採取手術治療為主。方法：回溯性分析鼻咽癌經放射線治療後頸部復發，並進行頸部手術的患者的資料。以Stata系統分析不同部位轉移、不同手術方式的存活率的資料以及是否有顯著差異。結果：自1994年至2009年於台北榮民總醫院被診斷為鼻咽癌並進行放射線治療的患者共1,127名。治療後發現頸部復發的患者共計26名（2.3%）。其中只有頸部復發的患者（regional recurrence）有19名、同時包含鼻咽部及頸部復發的患者（locoregional recurrence）有7名，26名患者中有22名進行頸部淋巴廓清手術。只有頸部復發的患者5年存活率為77%、同時包含鼻咽部及頸部復發的患者5年存活率為35%，兩者間有顯著差異（p＜0.05）。而在只有頸部復發的患者族群中進行頸部淋巴全廓清術（radical neck dissection）、及選擇性頸部淋巴廓清手術（selective neck dissection）兩者的5年存活率分別為66.7%及87.5%，兩者之間並沒有顯著的差異（p＞0.05）。結論：原發性鼻咽癌治療方式以放射線治療為主，復發率極低（2.3%）。然而當頸部復發時，則頸部淋巴廓清手術為主要的治療方針。患者同時包含鼻咽部及頭頸部復發的患者比只有頸部復發的患者5年存活率低，頸部淋巴廓清手術的種類則對5年存活率沒有顯著的影響。
並列摘要
BACKGROUND: Nasopharyngeal carcinoma (NPC) patients may have recurrent neck lesions after treatment. Radical or selective neck dissection is effective for the treatment of cervical failure in NPC. METHODS: We retrospectively reviewed 26 NPC patients with recurrent neck lymphadenopathy after radiotherapy who received salvage surgery between 1994 to 2009. The survival and cervical control rates of the patients that received radical neck dissection (RND) or selective neck dissection (SND) were analyzed. RESULTS: In the regional recurrent patients, the 5-year overall survival rate (OS) in SND and RND groups were 87.5% and 66.7%, respectively, and the diseasefree survival rate (DFS) were 87% and 62.5%, respectively. The differences were insignificant. Otherwise, there is a significant difference in the 5-year OS rate between the groups of locoregional recurrence (35%) and regional recurrence (77%). CONCLUSIONS: Neck dissection is effective in patients with regional or locoregional recurrent nasopharyngeal carcinoma. Level II is the most common cervical recurrence level. The RND or SND were effective to treat cervical recurrence in NPC. The progression of locoregional recurrence was poor and survival rate was relatively low as compared with the only regional recurrence group.
延伸閱讀
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