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【文摘发布】6-7 同时放化疗治疗局部晚期口咽癌

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6-7 同时放化疗治疗局部晚期口咽癌

Concurrent chemoradiation for locally advanced oropharyngeal cancer

American Journal of Otolaryngology–Head and Neck Medicine and Surgery 28 (2007) 3– 8

Nam P. Nguyen, MDa,b,4, Paul Vos, PhDd, Herbert J. Smith, MDc, Phuc D. Nguyen, MDa,b, Alan Alfieri, PhDe, Ulf Karlsson, MD, PhDf, Suresh Dutta, MDg, Claire Lemanski, MDh, Ly M. Nguyen, BSi, Sabah Sallah, MDj

Purpose: The aim of this study was to assess the survival, pattern of failure, morbidity, and prognostic factors of concurrent chemoradiation for locally advanced oropharyngeal cancer.
Materials and methods: A retrospective survey of patients who underwent chemotherapy and radiation for locally advanced oropharyngeal carcinoma at the Veteran Affairs North Texas Health Care System, Dallas, Tex.
Results: Between December 1999 and September 2004, 48 patients with locally advanced oropharyngeal cancer underwent concurrent chemotherapy and radiation. At a median follow-up of 23 months, the 3- and 5-year survival for the whole group were, respectively, 52% and 41%. Seventeen patients (35%) developed recurrences. There were 12 (25%) locoregional failures (6 local failures alone and 6 local and regional failures). Distant metastases developed in 8 patients (5 alone, 3 associated with locoregional failures). Four patients (8%) developed second primaries. No difference was observed in survival between base of tongue and tonsillar carcinoma ( P = .32). The 5-year survival for T1-T2 and T3-T4 tumors was, respectively, 84% and 27% ( P = .01). No patient with T1-T2 tumors developed distant metastases ( P = .04). Forty-five patients (94%) developed
toxicity grade 3 to 4 (40 mucositis and 26 hematological). The median weight loss was 18 lb (range, 0–47 lb). Eight patients (16%) developed aspiration pneumonia during and after treatment. Five patients (10%) died of aspiration (2 during and 3 post treatment). Four patients (8%) developed esophageal strictures requiring repeated dilatations post treatment. Two patients had radionecrosis (1 soft tissue and 1 bone) requiring hyperbaric oxygen. Eighteen patients (37%) had prolonged tube
feedings (N3 months) after treatments because of severe dysphagia or aspiration.
Conclusion: Concurrent chemoradiation provided good locoregional control for locally advanced oropharyngeal carcinoma. Patients with small tumors (T1-T2) had excellent survival. The poor prognosis associated with large tumors may be due to the risk of developing distant metastases. Acute and late toxicities remained significant. Aspiration pneumonia and severe dysphagia were the most prevalent complications of the combined modality approach.

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同时放化疗治疗局部晚期口咽癌

Concurrent chemoradiation for locally advanced oropharyngeal cancer

American Journal of Otolaryngology–Head and Neck Medicine and Surgery 28 (2007) 3– 8

Nam P. Nguyen, MDa,b,4, Paul Vos, PhDd, Herbert J. Smith, MDc, Phuc D. Nguyen, MDa,b, Alan Alfieri, PhDe, Ulf Karlsson, MD, PhDf, Suresh Dutta, MDg, Claire Lemanski, MDh, Ly M. Nguyen, BSi, Sabah Sallah, MDj

Purpose: The aim of this study was to assess the survival, pattern of failure, morbidity, and prognostic factors of concurrent chemoradiation for locally advanced oropharyngeal cancer.
目的：这项研究的目的是获取同时放化疗治疗局部晚期口咽癌的生存率、失败类型、死亡率和预测因子。

Materials and methods: A retrospective survey of patients who underwent chemotherapy and radiation for locally advanced oropharyngeal carcinoma at the Veteran Affairs North Texas Health Care System, Dallas, Tex.
材料和方法：位于美国德克萨斯州达拉斯的北得克萨斯卫生保健系统是一个经验丰富的机构，研究入选正在这里进行放化疗治疗局部晚期口咽癌的患者并对这些患者进行回顾性调查研究。

Results: Between December 1999 and September 2004, 48 patients with locally advanced oropharyngeal cancer underwent concurrent chemotherapy and radiation. At a median follow-up of 23 months, the 3- and 5-year survival for the whole group were, respectively, 52% and 41%.

结果：在1999年12月到2004年9月之间，48名局部晚期口咽癌的患者接收了同时放疗和化疗。中期随访23个月，全组3年生存率和5年生存率分别为52％和41％。

Seventeen patients (35%) developed recurrences. There were 12 (25%) locoregional failures (6 local failures alone and 6 local and regional failures). Distant metastases developed in 8 patients (5 alone, 3 associated with locoregional failures). Four patients (8%) developed second primaries. No difference was observed in survival between base of tongue and tonsillar carcinoma ( P = .32). The 5-year survival for T1-T2 and T3-T4 tumors was, respectively, 84% and 27% ( P = .01). No patient with T1-T2 tumors developed distant metastases ( P = .04).

17例患者（35％）复发。12例（25％）局部区域失败（6例仅局部失败，6例局部和区域失败）。8例患者进展为远处转移（5例为单纯转移，3例与局部区域失败相关）。4例患者（8％）进展为二次原发肿瘤。观察到的舌根癌和扁桃体癌的生存率无显著差异（P =0 .32）。T1-T2 和 T3-T4肿瘤患者的5年生存率分别为84% 和27% ( P = 0.01)。没有T1-T2期肿瘤患者进展为远处转移( P =0 .04)。

Forty-five patients (94%) developedtoxicity grade 3 to 4 (40 mucositis and 26 hematological). The median weight loss was 18 lb (range, 0–47 lb). Eight patients (16%) developed aspiration pneumonia during and after treatment. Five patients (10%) died of aspiration (2 during and 3 post treatment). Four patients (8%) developed esophageal strictures requiring repeated dilatations post treatment. Two patients had radionecrosis (1 soft tissue and 1 bone) requiring hyperbaric oxygen. Eighteen patients (37%) had prolonged tube feedings (N3 months) after treatments because of severe dysphagia or aspiration.

45例患者（94％）进展为3到4级毒性作用（40例黏膜炎和26例血液疾病）。体重减轻中值为18磅（范围，0-47磅）。8例患者（16％）在治疗期间和治疗后发生吸入性肺炎。5例患者(10%)死于误吸（2例在治疗期间，3例在治疗后）。4例患者(8%)治疗后发生食道狭窄需要反复食道扩张。2例患者有放射性坏死（1例为软组织，1例为骨）需要高压养治疗。8例患者(37%)治疗后因为严重的吞咽困难和误吸而持续管饲。

Conclusion: Concurrent chemoradiation provided good locoregional control for locally advanced oropharyngeal carcinoma. Patients with small tumors (T1-T2) had excellent survival. The poor prognosis associated with large tumors may be due to the risk of developing distant metastases. Acute and late toxicities remained significant. Aspiration pneumonia and severe dysphagia were the most prevalent complications of the combined modality approach.

结论：同时放化疗可以很好的局部区域控制局部晚期口咽癌。小肿瘤患者(T1-T2)有极高的生存率。预后不良与大肿瘤相关可能主要是由于进展为远处转移的风险。急性和迟发性毒性作用仍然显著。吸入性肺炎和严重吞咽困难是最主要的并发症并且常常联合导致死亡。

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（771字）

同时放化疗治疗局部晚期口咽癌

据《美国耳鼻咽喉头颈医学和外科学杂志》近期杂志报道：Nam P. Nguyen医学博士等的研究发现：同时放化疗可以很好的控制局部晚期口咽癌。小肿瘤患者(T1-T2)有极高的生存率。预后不良与大肿瘤相关，主要是进展为远处转移。放化疗的急性和迟发性毒性作用显著。吸入性肺炎和严重吞咽困难是最主要的并发症并且常常联合导致死亡。（American Journal of Otolaryngology–Head and Neck Medicine and Surgery 28 (2007) 3– 8网络版）

Nam P. Nguyen医学博士等希望通过这项研究获取同时放化疗治疗局部晚期口咽癌的生存率、失败类型、死亡率和预测因子。位于美国德克萨斯州达拉斯的北得克萨斯卫生保健系统是一个经验丰富的机构，研究入选正在这里进行放化疗治疗局部晚期口咽癌的患者并对这些患者进行回顾性调查研究。研究发现：在1999年12月到2004年9月之间，48名局部晚期口咽癌的患者接收了同时放疗和化疗。中期随访23个月，全组3年生存率和5年生存率分别为52％和41％。17例患者（35％）复发。12例（25％）局部区域失败（6例仅局部失败，6例局部和区域失败）。8例患者进展为远处转移（5例为单纯转移，3例与局部区域失败相关）。4例患者（8％）进展为二次原发肿瘤。观察到的舌根癌和扁桃体癌的生存率无显著差异（P =0 .32）。T1-T2 和 T3-T4肿瘤患者的5年生存率分别为84% 和27% ( P = 0.01)。没有T1-T2期肿瘤患者进展为远处转移( P =0 .04)。45例患者（94％）进展为3到4级毒性作用（40例黏膜炎和26例血液疾病）。体重减轻中值为18磅（范围，0-47磅）。8例患者（16％）在治疗期间和治疗后发生吸入性肺炎。5例患者(10%)死于误吸（2例在治疗期间，3例在治疗后）。4例患者(8%)治疗后发生食道狭窄需要反复食道扩张。2例患者有放射性坏死（1例为软组织，1例为骨）需要高压养治疗。8例患者(37%)治疗后因为严重的吞咽困难和误吸而持续管饲。
综上所述该研究得出以下结论：同时放化疗可以很好的局部区域控制局部晚期口咽癌。小肿瘤患者(T1-T2)有极高的生存率。预后不良与大肿瘤相关可能主要是由于进展为远处转移的风险。急性和迟发性毒性作用仍然显著。吸入性肺炎和严重吞咽困难是最主要的并发症并且常常联合导致死亡。（丁香）

2007-06-30 19:46

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