局部晚期头颈部鳞状细胞癌术后同期放化疗的疗效分析  

Postoperative chemoradiotherapy for locally advanced head and neck squamous cell carcinoma

作　　者：邱幸生[1] 刘宜敏[1] 毕卓菲[1] 谢德荣[1] 

机构地区：[1]中山大学孙逸仙纪念医院肿瘤科,广州510120

出　　处：《中华临床医师杂志（电子版）》2014年第14期54-57,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的观察局部进展期头颈部鳞状细胞癌术后放疗,同期多西他赛联合顺铂方案化疗的疗效,探讨提高术后放疗疗效的方法。方法回顾性分析2008年3月至2011年12月行术后同期放化疗的79例头颈部鳞状细胞癌患者治疗资料,原发灶位于口咽、喉或喉咽,术后有以下高危因素:淋巴结包膜外侵犯;手术切缘阳性;病理学为T4或N2、N3。根据复发风险处方照射剂量,同期多西他赛联合顺铂方案化疗,3周1次。用Kaplan-Meier法分析生存获益及无进展生存率,RTOG毒性标准评价放疗引起的急性与晚期毒性反应,NCI化疗毒性标准评价化疗毒性反应。结果中位随访38个月,全组共9例发生局部区域复发。2年局部区域控制率92%,2年无进展生存率75%,2年总体生存率87%。Ⅲ度或以上治疗相关毒性反应:粒细胞缺乏(59%),黏膜损伤(47%),口干(6%),肌纤维化(10%),吞咽困难(8%)及皮肤损伤(13%),9例患者发生咽瘘,无治疗相关死亡。结论局部进展期头颈部鳞状细胞癌术后放疗,同期多西他赛联合顺铂方案化疗是安全、有效的治疗手段。Objective To investigate the efficacy of postoperative radiotherapy concurrent with docetaxel plus cisplatin for locally advanced head and neck squamous cell carcinoma （HNSCC）. Methods The records of 79 patients presenting with primary HNSCC from March 2008 to December 2011 were reviewed. Patients had squamous-cell carcinoma with primary sites at oropharynx, larynx, or hypopharynx; All had undergone macroscopically complete resection of disease with high-risk characteristics （any or all of the following： extracapsular extension of nodal disease, positive resection margins, pathological stage T4 primary or N2 or N3 node disease）. All patients received postoperative radiotherapy concurrent with docetaxel plus cisplatin, dose was tailored to target volume according to pathological risk factors. Kaplan-Meier method were used to analyze survival benefit and progression free survival rate, treatment-related adverse effects were scored according to the Common Toxicity Criteria of the National Cancer Institute, version 2.0, for chemotherapy and according to RTOG criteria for radiotherapy. Results After a median follow-up of 38 months, local or regional recurrence as the first site of treatment failure occurred in 9 patients （16 percent）. The estimated two-year rate of local and regional control was 92%. The estimated two-year rate of disease-free survival was 75%, overall survival was 87%. The treatment related severe （Grade 3 or higher） adverse effect were granulocytopenia（59%）, mucositis（47%）, xerostomia（6%）, muscular fibrosis（10%）, dysphagia （8%） and dermatitis （13%）, Pharyngocutaneous fistula occurred in 9 patients. No treatment related death occurred. Conclusion Treatment with postoperative concurrent cisplatin plus docetaxel and radiotherapy is effective with an acceptable toxicity profile.

关 键 词：头颈部肿瘤 癌 鳞状细胞 放射疗法 药物疗法 

分 类 号：R739.91[医药卫生—肿瘤]