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晚期下咽癌治療方式改變對存活率的影響

The Impact on Survival after Change of Treatment Modalities in Advanced Hypopharyngeal Cancer

摘要


BACKGROUND: Surgery followed by irradiation is usually considered to be the standard treatment for advanced stage of hypopharyngeal cancer with sacrificing natural speech. The prognosis of hypopharyngeal cancer was still poor though ablative treatment modalities performed. The concept of organ preservation was accepted recently after development of new medical drugs and radiotherapy technique. The goal of this study is to analyze the survival between different eras (2004-2006 vs 2007-2009) with shift treatment modalities.MATERIAL AND METHODS: The study was approved by the Institutional Review Board of Mackay Memorial Hospital (IRB No.10MMHIS092). A retrospective review of eighty patients who were diagnosed to be suffered from locally advanced cancer of hypopharynx (stage III, IVA, excluding early stage, incompletely treated and IVB, IVC cases) and treated at Mackay Memorial Hospital between 2004 and 2009, were studied. These patients were divided into two groups with 2004-2006 (Section A) and 2007-2009 (Section B). The principle of head and neck cancer management in Mackay Memorial Hospital was changed after 2007. Sequential chemoradiotherpy for larynx preservation was recommended first for patients of advanced hypopharyngeal cancer. Salvage operation was suggested if tumor response is less than 50% after two or four courses of induction chemotherapy (ICT). Both sections (Section A and B) were analyzed as either (1) a non-surgery group with main treatment of concurrent chemotherapy and radiotherapy (CCRT)(group I) or (2) an operation group (all total laryngectomy) plus CCRT (group II). Estimates of survival were computed with Kaplan-Meier product limit method. All data were analyzed with SPSS 12.0 statistical software system (SPSS Inc. Chicago IL, USA). A p-value of < 0.05 was considered statistically significant.RESULTS: In section A, eleven patients (Stage IVA: 8) were enrolled in group I, sixteen (Stage IVA: 13) in group II. In group I, four patients were received tracheostomy and one received laryngectomy after CCRT course. The larynx preservation rate is 54.5% (6/11). In section B, twenty-two patients (Stage IVA: 17) were enrolled in group I, five (Stage IVA: 5) in group II. In group I, three patients were received tracheostomy and another three received laryngectomy after CCRT course. The larynx preservation rate is 72.7% (16/22). The overall survival between two eras was similar with p value of 0.398 though treatment modalities had been changed. However, the analysis was statistically significant when compared with group I and II of 2004-2006 with p value is 0.016 so longer lifespan was obtained in surgical group.CONCLUSIONS: In section A, better survival was obtained in group II, and the recommended treatment was surgery plus CCRT. In section B, the accepted treatment options included surgery plus CCRT or CCRT or ICT plus CCRT with similar median overall survivals. Docetaxel or cetuximab combined with cisplatin may benefit survival in ICT or CCRT with successful larynx preservation in the future. New radiotherapy techniques as intensity-modulation may help in preserved anatomical and functional larynx. Since 2007, more than half patients have a preserved larynx, good function, and no signs of recurrence or complications today after receiving combination of chemotherapy and radiotherapy. However, we need to identify which effective modalities to fit most of these patients. Finally, survival after treatment of hypopharyngeal cancer should be improving, but more efforts are needed.

關鍵字

下咽癌 存活 治療

並列摘要


BACKGROUND: Surgery followed by irradiation is usually considered to be the standard treatment for advanced stage of hypopharyngeal cancer with sacrificing natural speech. The prognosis of hypopharyngeal cancer was still poor though ablative treatment modalities performed. The concept of organ preservation was accepted recently after development of new medical drugs and radiotherapy technique. The goal of this study is to analyze the survival between different eras (2004-2006 vs 2007-2009) with shift treatment modalities.MATERIAL AND METHODS: The study was approved by the Institutional Review Board of Mackay Memorial Hospital (IRB No.10MMHIS092). A retrospective review of eighty patients who were diagnosed to be suffered from locally advanced cancer of hypopharynx (stage III, IVA, excluding early stage, incompletely treated and IVB, IVC cases) and treated at Mackay Memorial Hospital between 2004 and 2009, were studied. These patients were divided into two groups with 2004-2006 (Section A) and 2007-2009 (Section B). The principle of head and neck cancer management in Mackay Memorial Hospital was changed after 2007. Sequential chemoradiotherpy for larynx preservation was recommended first for patients of advanced hypopharyngeal cancer. Salvage operation was suggested if tumor response is less than 50% after two or four courses of induction chemotherapy (ICT). Both sections (Section A and B) were analyzed as either (1) a non-surgery group with main treatment of concurrent chemotherapy and radiotherapy (CCRT)(group I) or (2) an operation group (all total laryngectomy) plus CCRT (group II). Estimates of survival were computed with Kaplan-Meier product limit method. All data were analyzed with SPSS 12.0 statistical software system (SPSS Inc. Chicago IL, USA). A p-value of < 0.05 was considered statistically significant.RESULTS: In section A, eleven patients (Stage IVA: 8) were enrolled in group I, sixteen (Stage IVA: 13) in group II. In group I, four patients were received tracheostomy and one received laryngectomy after CCRT course. The larynx preservation rate is 54.5% (6/11). In section B, twenty-two patients (Stage IVA: 17) were enrolled in group I, five (Stage IVA: 5) in group II. In group I, three patients were received tracheostomy and another three received laryngectomy after CCRT course. The larynx preservation rate is 72.7% (16/22). The overall survival between two eras was similar with p value of 0.398 though treatment modalities had been changed. However, the analysis was statistically significant when compared with group I and II of 2004-2006 with p value is 0.016 so longer lifespan was obtained in surgical group.CONCLUSIONS: In section A, better survival was obtained in group II, and the recommended treatment was surgery plus CCRT. In section B, the accepted treatment options included surgery plus CCRT or CCRT or ICT plus CCRT with similar median overall survivals. Docetaxel or cetuximab combined with cisplatin may benefit survival in ICT or CCRT with successful larynx preservation in the future. New radiotherapy techniques as intensity-modulation may help in preserved anatomical and functional larynx. Since 2007, more than half patients have a preserved larynx, good function, and no signs of recurrence or complications today after receiving combination of chemotherapy and radiotherapy. However, we need to identify which effective modalities to fit most of these patients. Finally, survival after treatment of hypopharyngeal cancer should be improving, but more efforts are needed.

並列關鍵字

Hypopharyngeal Cancer Survival Treatment

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