局部晚期下咽癌-基于放化疗的不同器官功能保留治疗模式的比较  

Comparison of different laryngeal preservation strategies based on chemoradiotherapy in locally advanced hypopharyngeal carcinoma

作　　者：罗希 孙士然 徐艺 黄晓东[1] 王凯[1] 吴润叶[1] 王静波[1] 张烨[1] 张江鹄[1] 陈雪松[1] 曲媛[1] 罗京伟[1] 易俊林[1] LUO Xi;SUN Shiran;XU Yi;HUANG Xiaodong;WANG Kai;WU Runye;WANG Jingbo;ZHANG Ye;ZHANG Jianghu;CHEN Xuesong;QU Yuan;LUO Jingwei;YI Junlin(Department of Radiation Oncology National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100021,China)

机构地区：[1]国家癌症中心,肿瘤临床研究中心,北京协和医学院中国医学科学院肿瘤医院放疗科,北京100021

出　　处：《临床耳鼻咽喉头颈外科杂志》2023年第9期708-714,共7页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:研究基于诱导化疗筛选放疗敏感患者(IC-directed)和基于早期放疗反应筛选放疗敏感患者(RT-directed)的保喉治疗策略在局部晚期可切除下咽癌中的临床特征和疗效比较。方法:回顾性分析中国医学科学院肿瘤医院2010年9月至2020年9月经病理证实的可切除局部晚期下咽癌患者,纳入接受IC-directed和RT-directed保喉治疗策略的231例患者。IC-directed模式是指患者先接受2个周期TPF方案诱导化疗,根据诱导化疗后的反应来决定后续治疗模式。如果原发灶缩小达到部分缓解(partial response,PR),则进行根治性同步放化疗;若原发灶缩小未达PR,则进行手术干预。RT-directed是利用早期放疗反应来筛选放疗敏感患者的综合治疗模式,具体是在放疗剂量达到50 Gy时,进行全面的分期检查和头颈部MDT评估,若原发灶缩小达到大PR(缩小达80%以上),则接受根治性放疗或同步放化疗;若原发灶缩小未达大PR,则休息4~6周后接受早期手术干预。研究终点为总生存时间(overall survival,OS)、无进展生存时间(progression free survival,PFS)、无局部区域复发生存(locoregional recurrence-free survival,LRRFS)、功能喉生存(survival with a functional larynx,SFL)。结果:本研究的中位随访时间为63.8个月。IC-directed组中有75.0%(57/76)患者在2个周期诱导化疗后达到PR,而RT-directed组中有70.3%(109/155)患者在放疗50 Gy时候疗效评价为大PR。全组患者的5年OS、PFS、LRRFS和SFL分别为47.9%、39.6%、44.3%和36.2%。比较2组治疗模式5年OS分别为51.3%和37.0%(HR 0.67;95%CI 0.43~1.05,P=0.07)。RT-directed治疗模式较IC-diercted治疗模式,在功能喉保留方面有显著优势,5年SFL分别为39.8%和27.8%(HR 0.68;95%CI 0.46~0.99;P=0.04),且两者手术并发症的发生率相似(P=0.60)。结论:在局部晚期可切除下咽癌中,相比于IC-directed的保喉治疗策略,RT-directed取得了较好的生存率和喉功能保全,且不增加手术并发症�Objective:This study aimed to evaluate the clinical features and treatment outcomes of the value of response-adapted treatment following radiotherapy and induction chemotherapy follwing subsequent comprehensive therapy in patients with resectable locally advanced hypopharyngeal carcinoma.Methods:This cohort study was conducted from September 2010 to September 2020 in our hospital,231 patients pathologically confirmed stage Ⅲ and ⅣB resectable locally advanced hypopharyngeal carcinoma included.For the IC-directed ART strategy,IC is used to select good candidates to receive radical RT or CCRT,and others undergo surgery.He response-adapted strategy was determined based on the primary tumor response,which was evaluated at a dose of 50 Gy.If the response reached complete response or partial response(more than 80% tumor regression),patients received radical RT or CCRT;otherwise,they received surgery,if possible,at 4 to 6 weeks after RT.The end points of the study were OS(overall survival),progression free survival(PFS),locoregional recurrence-free survival(LRRFS) and LDFS.Results:In IC-directed group,75.0%(57/76) patients reached PR after 2 cycles of induction chemotherapy.While in RT-directed group,70.3%(109/155) patients reached large PR at dose of 50 Gy.The median interquartile range follow-up period of the whole cohort was 63.8 months.The 5-year OS,PFS,LRRFS and SFL of the whole cohort were 47.9%、39.6%、44.3% and 36.2%,respectively.In evaluations based on the different treatment strategies,the 5-year OS and SFL were 51.3% versus 37.0%(HR 0.67;95%CI 0.43-1.05;P=0.07) and 27.8% versus 39.8%(HR 0.68;95%CI 0.46-0.99;P=0.04) between IC-directed and RT-directed groups.In additional,surgery complications did not significantly differ between these two groups.Conclusion:In this cohort study,the response-adapted strategy based on an early RT response facilitated better treatment tailoring,and higher laryngeal preservation compared with IC-directed strategies.This approach could provide a feasible laryngeal preservatio

关 键 词：下咽肿瘤 喉功能保全 诱导化疗 治疗反应 综合治疗 

分 类 号：R739.63[医药卫生—肿瘤]