小剂量顺铂化疗对早期声门型喉癌治疗的影响  

Impact of small doses of chemotherapy for patients with early glottic carcinoma

作　　者：李言冰[1] 蔡晓军[1] 李黎波[1] 

机构地区：[1]南方医科大学南方医院肿瘤科,广东广州510515

出　　处：《中国生化药物杂志》2014年第3期93-97,共5页Chinese Journal of Biochemical Pharmaceutics

基　　金：广东省科技计划项目(2010B031600246)

摘　　要：目的探讨手术、放疗和光动力治疗联合小剂量化疗治疗早期声门型喉癌的疗效和影响预后的因素。方法回顾性分析122例Tis^T_2N_0M_0期声门型喉癌患者的临床资料。122例患者中,小剂量化疗采用单药顺铂(按体表面积50 mg/m^2);共分为3组:行手术治疗联合小剂量化疗(手术组,n=83),行放疗联合小剂量化疗(放疗组,n=20)接受光动力治疗联合小剂量化疗(光动力组,n=19)。结果手术组、放疗组和光动力组的3年和5年总生存率(overall survival,0S)分别为92.7%、93.8%和89.5%、89.5%和84.4%、89.5%。手术组、放疗组和光动力组的2年无瘤生存率(disease-freesurvival,DFS)分别为87.6%、79.4%和78.6%。手术组、放疗组和光动力组治疗后的2年局部控制率(1ocal control,LC)分别为91.9%、84.4%和83.0%。3组中27例出现局部区域复发或颈部淋巴结转移,手术组中15例复发,放疗组中3例复发,光动力组5例复发,19例进行了挽救性手术。Cox多因素回归分析显示:前联合受侵、临床分期、治疗前卡氏评分是影响总生存率的独立因素。无瘤生存率的不良预后因素是前联合受侵(P=0.027)和分化程度(P=0.041),前联合受侵也是局部控制率(P=0.047)的不良预后因素。结论通过对早期声门型喉癌患者的回顾性分析,手术组、放疗组与光动力组3种治疗方法疗效相近,均达到了较好效果。光动力治疗和放射治疗可以作为早期声门型喉癌的主要治疗手段,光动力治疗和放疗联合小剂量化疗很大程度保存正常喉结构和功能,大幅度提高患者生活质量。治疗前KPS评分、声带活动受限及分化程度是影响OS的主要因素。Objective To investigate the curative effect of surgery,radiotherapy and photodynamic therapy combined with chemotherapy on early glottic carcinoma and prognostic factors.Methods Clinical data of 122 cases of early glottic carcinoma with Tis ~T2 N0 M0 were analyzed retrospectively.Small doses of chemotherapy applied to single drug cisplatin (according to the surface area of 50 mg/m2 ).83 patients underwent surgical treatments combined with chemotherapy,20 cases accepted radiotherapy combined with chemotherapy and 19 cases accepted photodynamic therapy combined with chemotherapy. Results The 3 and 5 years overall survival rates (overall survival,OS ) of surgery group,radiotherapy group and photodynamic group were 92.7%,93.8% and 89.5%,89.5% and 84.4% ,89.5%,respectively.The 2-year disease free survival rate (disease-freesurvival,DFS)were 87.6%,79.4%,78.6%,respectively.The 2-year local control rate(local control,LC)were 91.9%,84.4%,83.0%, respectively.27 cases suffered from tumor recurrence or metastasis,15 cases in the surgery group,3 cases in the radiotherapy group and 5 cases in the photodynamic group,among them 19 patients accepted salvage surgery.Multifactor retrospective analysis indicated anterior commissure invasion (P=0.047),clinical stage(P =0.018)and KPS score before treatment(P =0.001)were independent adverse prognostic factors for OS.Anterior commissure invasion(P=0.027)and differentiation degree(P=0.041)were adverse prognostic factors for DFS.Anterior commissure invasion was also poor prognostic features for LC(P=0.047).Conclusion Radiotherapy and photodynamic therapy combined with chemotherapy may be the first or very important treatment on early stage glottic squamous cell cancer(Tis ~T2N0M0 ).High preservation rate of laryngeal function with radiotherapy and photodynamic therapy combined with chemotherapy can significantly improved quality of life of patients.Curative effect of three groups was similar,and three kinds of curative methods achieved good effect.KPS score before treatment,glottis impai

关 键 词：早期声门型喉癌 手术治疗 放疗 光动力治疗 化疗 预后因素 

分 类 号：R739.6[医药卫生—肿瘤]