Treatment results and prognostic factors in locally advanced hypopharyngeal cancer

CONCLUSIONS: We suggest that concurrent chemoradiation (CCRT) is an effective definitive treatment for patients with advanced hypopharyngeal carcinoma who are unfit for or refuse surgery. A high dose of radiation (> 70 Gy) should be given to achieve acceptable local control rates and survival. OBJECTIVES: The purpose of this retrospective study was to compare the treatment results of locally advanced hypopharyngeal carcinoma with two different protocols. PATIENTS AND METHODS: From December 1995 to December 2004, 74 patients with locally advanced hypopharyngeal cancer were treated with CCRT or surgery plus postoperative radiotherapy (SRT). Their treatment results were reviewed by retrospective analysis. The study points included outcome, toxicity, and prognostic factors. RESULTS: There was no significant difference in T and N status between the two treatment groups, nor were there significant differences in overall or disease-free survival or the incidence of distant metastasis (p >0.05). In the CCRT group and SRT group, the estimated 3-year overall survival was 39% and 44%, respectively. The SRT group had better local control than the CCRT group (p <0.05). Relatively, 27% patients retained their larynx function for more than 2 years in the CCRT group. Radiation doses >70 Gy yielded significantly better survival and local control than doses <70 Gy (p <0.05).     

Treatment outcomes for radiotherapy alone are comparable with neoadjuvant chemotherapy followed by radiotherapy in early-stage nasopharyngeal carcinoma

OBJECTIVES: To analyze the impact of neoadjuvant chemotherapy (CT) on the treatment of early-stage nasopharyngeal carcinoma (NPC) as compared with radiotherapy (RT) alone. METHODS: We analyzed retrospectively the outcome of 60 previously untreated and histologically confirmed early-stage NPC patients treated with either RT alone or with neoadjuvant CT followed by RT (CT/RT) at the Seoul National University Hospital between 1986 and 2004. Neoadjuvant CT consisted of three cycles with 5-fluourouracil and cisplatin. RT was given to the nasopharynx and neck nodes. The median dose to the primary site, involved nodes, and elective nodes was 70.2 Gy, 63 Gy, and 45 Gy, respectively. According to the 1997 American Joint Committee on Cancer staging system, 9 patients had stage I or IIA disease, and 22 patients had stage IIB disease in the RT group. For the CT/RT group, 8 patients had stage I or IIA disease, and 21 patients had stage IIB disease. The median follow-up for all patients was 124.5 (range, 5-239) months. RESULTS: The 5-year locoregional failure-free (LRFF), distant metastasis-free (DMF), disease-free survival (DFS), and overall survival (OS) rate was 84%, 93%, 81%, and 84% for the RT group and 77%, 86%, 71%, and 79% for the CT/RT group, respectively. There were no significant differences in LRFF (P = .728), DMF (P = .433), DFS (P = .562), and OS (P = .625) rates between the RT and CT/RT groups. Multivariate analysis revealed that delaying RT for more than 81 days was significantly associated with an increased risk of locoregional failure in the subgroup of patients with stage IIB disease (P = .044). CONCLUSIONS: In our retrospective analysis, the use of neoadjuvant CT showed no additional benefit to treatment with RT alone. Neoadjuvant CT may cause deleterious effect on stage IIB disease by delaying RT.     

局部晚期鼻咽癌新辅助化疗联合同步放化疗

鼻咽癌是我国南部地区最常见恶性肿瘤之一,大部分患者被发现时已处于局部晚期.鼻咽癌对放、化疗比较敏感,过去认为同步放化疗方案是鼻咽癌的标准治疗方式;研究显示新辅助化疗联合同步放化疗对局部晚期鼻咽癌患者的治疗效果更佳.然而调强放疗与传统放疗技术相比,在保证原有治疗效果基础上可进一步降低患者的毒副反应.本文比较在传统放疗与调强放疗技术两种情况下,同步放化疗与同步放化疗联合新辅助化疗的两种方案对局部晚期鼻咽癌患者治疗效果做一综述.     

中期舌体鳞状细胞癌的预后及诱导化疗在治疗中的价值

目的 探讨诱导化疗在中期舌体鳞癌治疗中的价值,以及影响中期舌体鳞癌预后的因素.方法 回顾性分析1990年1月-1999年12月间首次在中山大学肿瘤防治中心头颈科住院治疗的符合条件的cTNM中期(Ⅱ、Ⅲ期,T2-3NO或T1-3N1)舌体鳞癌患者122例.单纯手术69例,诱导化疗后手术治疗53例,其中顺铂+5-氟尿嘧啶+博来霉素A5(简称PBF方案)诱导化疗17例,博来霉素A5单药诱导化疗36例.Kaplan-Meier法计算累积生存率,Cox比例风险模型进行多因素分析.结果 全组随访时间为7～177个月,平均随访(79.9±49.8)个月(-x±s),死亡45例(包括5例失访),失访率4.1%,存活77例中66例随访5年以上.全组3年、5年生存率分别为79.4%、69.0%,无瘤生存率分别为71.7%、66.3%;单纯手术组的3年、5年生存率分别为82.5%、73.1%,PBF方案组的3年、5年生存率分别为82.4%、70.1%,博来霉素单药诱导化疗后手术的3年、5年生存率分别为72.2%、61.1%,各组间比较差异无统计学意义(χ2=0.42,P=0.8106);单纯手术、PBF诱导化疗后手术、博来霉素诱导化疗后手术组的复发率分别为30.4%、41.2%和38.9%;单因素分析显示诱导化疗未见提高患者生存率、降低局部区域复发率(χ2=1.148,P=0.563)和远处转移率(χ2=2.305,P=0.316);多因素分析显示舌癌复发是影响预后的独立因素.结论 舌癌复发是影响中期舌体鳞癌预后的独立因素.诱导化疗未见提高患者生存率,降低复发率和远处转移率,PBF方案和博来霉素单药方案对舌体鳞癌的诱导化疗疗效差异无统计学意义.     

放化疗联合治疗局部晚期鼻咽癌的临床研究

目的：探讨放化疗交替疗治疗局部晚期鼻咽癌的临床疗效。方法：回顾性分析106例局部晚期鼻咽癌患者临床资料。单纯放疗15例;91例接受PF方案为基础的诱导化疗和（或）辅助化疗,其中诱导化疗加放疗加辅助化疗36例,诱导化疗加放疗25例,放疗加辅助化疗30例。诱导化疗1～2周期,辅助化疗3～6周期。放疗于诱导化疗结束后第1天进行,辅助化疗在放疗结束后1周开始进行。鼻咽原发灶采用60Co,常规分割照射68-74Gy,颈部根治量60～70Gy,颈部预防量48～50Gy,每组均完成根治量放疗。结果：中位随访时间51个月,58例患者死亡,全组总生存率为45．3％。单纯放疗、诱导化疗加放疗加辅助化疗、诱导化疗加放疗、放疔加辅助化疗的5年总生存率分别为33％、63％、60％、50％,无瘤生存率分别为13％、56％、48％、40％,无局部复发率分别为13％、53％、48％、50％,无远处转移率分别为6％、50％、44％、47％,均差异有统计学意义（P〈0．05）。各组发生复发、转移的中位时间分别为22、29、28、25个月;10、19、15、12个月,均差异无统计学意义（P〉0．05）。诱导化疗加放疗加辅助化疗组急性毒性反应较其他组重,但未影响治疗进程,患者均可耐受。结论：诱导化疗和辅助化疗联合尽早开始的放疗治疗局部晚期鼻咽癌疗效较好,不良反应轻,适合局部晚期鼻咽癌患者的综合治疗。     

Preoperative chemotherapy-sensitized radiation therapy for cervical metastases in head and neck cancer

OBJECTIVE: To determine the efficacy of concurrent preoperative cisplatin chemotherapy and radiotherapy (CT/RT) for patients with advanced head and neck cancer and cervical metastatic disease. DESIGN: Retrospective analysis. SETTING: University hospitals. PATIENTS: Eighty-eight patients with operable stage III and IV squamous cell carcinoma of the head and neck and palpable cervical lymphogenous metastases received preoperative concurrent CT/RT followed by planned neck dissection. INTERVENTIONS: All patients undergoing CT/RT received concomitant continuous infusions of cisplatin (20 mg/m2) on days 1 to 4 and 22 to 25 of CT/RT. Thirty-nine patients underwent single-fraction (1.8-Gy) radiotherapy to 45.0 Gy, and 49 patients received 10 single-fraction (1.8-Gy) treatments, which were hyperfractionated (1.2-Gy twice a day) to 46.8 Gy. MAIN OUTCOME MEASURES: The 71 patients for whom complete post-CT/RT data were available were evaluated for clinical response in addition to survival. Histologic complete response (HCR) was confirmed from planned neck dissection specimens (n = 48) after clinical complete response (CCR) from initial CT/RT. Kaplan-Meier statistical analysis for disease-specific survival and overall survival was performed on all 88 patients who received CT/RT. RESULTS: A CCR and an HCR were noted in 78% (18/23) and 59% (10/17) of patients with N1 lesions, respectively, and in 60% (29/48) and 45% (14/31) of patients with N2-3 lesions, respectively. The percentage of patients with CCR who also had HCR was 67% (10/15) for patients with N1 lesions and 54% (14/26) for patients with N2-3 lesions. With a median follow-up of 18.5 months, the Kaplan-Meier disease-specific survival rate at 54 months (n = 88) was 70% (21/30) for patients with N1 lesions, 60% (24/40) for patients with N2 lesions, and 39% (7/18) for patients with N3 lesions. The overall survival and disease-specific survival rates at 5 years for all nodal groups combined were 36% (32/88) and 59% (52/88), respectively. CONCLUSIONS: A CCR to CT/RT was achieved in nearly two thirds of patients with head and neck cervical lymphogenous metastases, independent of nodal tumor load. Most patients (59% [24/41]) with CCR were pathologically tumor free before neck dissection.     

Survival and failure outcomes in locally advanced esthesioneuroblastoma: a single centre experience of 15 patients

Esthesioneuroblastoma (ENB) constitutes 3 % of all malignant intranasal tumors. As the tumor is very rare, the number of patients of ENB treated in individual departments is small. We present our institute’s experience in combined modality management of 15 successive patients of ENB treated from 2006 to 2010. Clinical characteristics and treatment modality in form of surgery, radiotherapy and chemotherapy were noted. Kadish stage C was the most common stage (12 patients) followed by stage B (3 patients). Fourteen patients underwent primary surgery, of which nine had total excision and five had subtotal excision. One patient was treated with combination of chemotherapy (CT) and radiotherapy (RT). Median RT dose delivered was 54 Gy. Twelve patients received CT with cisplatin and etoposide. Overall, eight patients had complete response, five had partial response, while one had static disease and progressive disease each. Two patients had distant metastases. Four-year loco-regional control (LRC) was 25 % and 4-year overall survival (OS) was 45 %. Most common presentation in our series was locally advanced tumors. Most of these patients require adjuvant RT, which helps in significant LRC. Systemic CT benefits in inoperable, advanced and high risk tumors. Risk-adapted and multimodality approach is the need of hour to achieve good control rates while minimizing treatment related toxicity.     

T-status and an oral fluoropyrimidine,S-1, adjuvant chemotherapy are prognostic factors in reduced-RADPLAT for resectable hypopharyngeal cancer

Conclusion: Reduced-RADPLAT for HPC achieved comparative survival and locoregional control rates with lower toxicities compared with concurrent chemoradiotherapies including original RADPLAT. S-1 adjuvant chemotherapy showed a survival benefit. Objectives: To evaluate the efficacy and toxicities of targeted intra-arterial (IA) infusion of cisplatin with concurrent radiotherapy with a reduced dose (reduced-RADPLAT) for resectable hypopharyngeal cancer (HPC). Methods: Between 1999–2012, 50 patients with stage II–IVA HPC primarily treated by reduced-RADPLAT were analyzed. They were treated by 2–5 courses of IA cisplatin infusion (100?mg per body) with simultaneous systemic infusion of sodium thiosulfate concurrent with conventional radiotherapy (66–70?Gy). After 2003, S-1, an oral fluoropyrimidine, adjuvant chemotherapy was administered to all eligible patients. Results: During a median follow-up of 48.6 months, the estimated 3- and 5-year overall survival (OS), progression-free survival (PFS), locoregional control, and laryngoesophageal dysfunction-free survival (LEDFS) rates were 76.0% and 62.0%, 58.0% and 50.0%, 66.0% and 62.0%, and 56.0% and 54.0%, respectively. Grade 3 toxicities were observed in 30.0%. No patient had grade 4 or higher toxicities. No patient required tube feeding or tracheotomy at 3 months after treatment. T4-lesions and S-1 administration were significant factors predicting poor and good OS, PFS, and LEDFS, respectively.     

Contemporary therapeutic management of locally advanced hypopharyngeal cancer: oncologic and functional outcomes – a report on 100 cases

Conclusion: A significant proportion of patients with locally advanced hypopharyngeal cancer could not be managed by larynx-sparing therapy. T4 stage is one of the main predictive factors of oncologic and functional outcomes. Objectives: To analyze the therapeutic management of patients with locally advanced hypopharyngeal cancer in clinical practice and to report oncologic and functional outcomes. Methods: This was a retrospective study of all patients treated for a locally advanced hypopharyngeal squamous cell carcinoma between 2001 and 2012 at our institution. Results: A total of 100 patients were included in this study. Induction chemotherapy (CT) followed by radiotherapy (RT) ± CT, primary RT + CT, and primary total pharyngolaryngectomy (TPL) comprised the initial therapeutic management for 54, 24, and 20 patients, respectively. Two patients received only supportive care. Overall survival (OS) and cause-specific survival (SS) were 50% and 60% at 3 years, respectively. In the group of patients referred for induction CT, the 3-year OS and SS were 58% and 70%, respectively. In multivariate analysis, T stage (p = 0.05) and ASA score (p = 0.02) were significant predictive factors of OS. T4 tumor stage had a pejorative impact on swallowing function after therapy (p = 0.006). The rate of patients alive, disease-free, and with a functional larynx at 2 years was 23%.     

Results of an organ preservation protocol with induction chemotherapy and radiotherapy in patients with locally advanced pyriform sinus carcinoma

An alternative to the classical treatment for locally advanced (T3-T4 stage) pyriform sinus carcinoma with surgery and postoperative radiotherapy is to begin treatment with induction chemotherapy in an organ preservation approach. In patients with complete clinical response, this treatment is followed by radiotherapy; in non-complete responders, it is followed by surgery and postoperative radiotherapy. We conducted a retrospective study to evaluate such treatment in a cohort of 78 patients with locally advanced pyriform sinus carcinoma treated at a single institution between 1985 and 1997. In all patients, induction chemotherapy with cisplatin and 5-fluoruracil was carried out. Two patients died as a consequence of complications associated with chemotherapy treatment. Of the 76 patients who completed treatment, 23 (30%) achieved a complete response at the primary site, 38 (50%) attained a partial response, and 15 patients (20%) had a stabilization-progression. The 5-year adjusted survival of patients treated with radiotherapy alone was 57% and, in patients treated with surgery, 51%. There were no significant differences in survival related to the subsequent treatment used (P > 0.05). The larynx was preserved in 14 of the 23 patients (61%) who completed treatment with induction chemotherapy and radiotherapy. The frequency of organ preservation for the group of 78 patients who began treatment with induction chemotherapy was 18%. Received: 20 October 2000 / Accepted: 28 June 2001     

T3和T4期梨状窝癌的综合治疗

目的评价不同治疗方式治疗梨状窝癌T3、T4病变的治疗效果。方法回顾性分析了1974年1月-1999年12月中国医学科学院肿瘤医院头颈外科初治的287例T3、T4梨状窝癌患者。根据治疗方式，分为4组：单纯放疗组（Ra组）134例，平均放疗剂量68．8Gy；术前放疗加手术组（R＋S组）125例，平均术前放疗剂量45．5Gy，其中32例行喉功能保留手术；单纯手术组（Sa组）13例，全部为非喉功能保留手术；手术加术后放疗组（S＋R组）15例，全部为非喉功能保留手术，平均术后放疗剂量56．3Gy。结果Kaplan-Meier方法计算Ra组、R＋S组、Sa组和S＋R组的5年生存率分别为23．13％、46．51％、18．33％和44．44％。综合治疗（R＋S组和S＋R组）与单纯治疗（Ra组和Sa组）的5年生存率分别为46．22％和22．60％，两组间差异有统计学意义（P=0．000）。Cox模型对生存时间的多因素分析显示，对生存时间有影响的是治疗模式（P=0．000）和放疗效果（P=0．0070）Ra组、R＋S组、Sa组和S＋R组的喉功能保存率分别为14．08％、13．61％、0和0。Ra组、R＋S组、Sa组和S＋R组的并发症的发生率分别为14．93％、37．60％、53．84％、33．33％。结论术前放疗有助于T3、T4梨状窝癌患者喉功能的保留。     

Concurrent chemo-radiotherapy for nasopharyngeal carcinoma

OBJECTIVE: Because of the low incidence of nasopharyngeal carcinoma (NPC) in Japan, few studies have reported on the use of concurrent chemo-radiotherapy (CCRT) for treatment of this disease. The present study investigated the efficacy and toxicity of CCRT with Carboplatin (CBDCA) and UFT for NPC. PATIENTS AND METHODS: CCRT with injection of CBDCA and oral administration of UFT was given to 21 patients in our institution during 1996-2000. We compared the patients treated with CCRT with those treated with RT alone from 1976 to 1995 or those treated with RT after chemotherapy (Pre-RT chemotherapy) from 1985 to 1995. Overall survival rate (OS), progression free survival rate (PFS) and cause specific survival (CSS) rate were analyzed. RESULTS: The actual 2-year OS, PFS, and CSS of CCRT were 85.7, 66.7 and 90%, respectively. The rates were improved compared to RT alone (37.9, 31.0, and 56.6%) and Pre-RT chemotherapy (58.8, 41.2, and 64.7%). The most frequent and severe acute toxicities were leukopenia (42.9%) and mucositis with grade 3-4 (28.6%), both of which eventually resolved. CONCLUSION: CCRT with CBDCA and UFT is considered to be an effective, convenient, and tolerable treatment, which improves survival rates for NPC patients. Therefore, we recommend this CCRT method for the treatment of NPC.     

Paclitaxel with cisplatin in concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma

The aim of this study was to evaluate the efficacy and the toxicity of paclitaxel and cisplatin in patients in concurrent radiotherapy for locally advanced nasopharyngeal carcinoma, and to see whether such a regime would be better tolerated than high dose cisplatin plus fluoracil in Chinese patients. Thirty-one patients with locally advanced nasopharyngeal carcinoma were enrolled. Patients were scheduled to receive two courses of concomitant chemotherapy, starting on day 1 and then day 28 during radiotherapy (70–76 Gy in 35–38 fractions in 7–7.5 weeks). Chemotherapy was given by intravenous infusion, paclitaxel 120 mg/m² in 3 h, cisplatin 75 mg/m² (25 mg/m² days 1–3). Adjuvant therapy was paclitaxel 135 mg/m² in 3 h, cisplatin 75 mg/m² (25 mg/m² days 1–3) on weeks 3, 6, 9 after radiotherapy. All patients completed radiotherapy, but for concomitant chemoradiotherapy, 20 of the 31 patients completed the 2 cycles of chemotherapy, while the other 11 could only receive 1 cycle due to various reasons. The median follow-up was 40 months, 2 patients developed locoregional recurrences, one of whom in the cervical lymph nodes, the other in the nasopharynx. The 3-year overall survival rate was 83.9% and the distant metastasis rate at 3 years was 13.6%. Grade 3–4 toxicities were neutropenia 12.9%, anaemia 6.45%, thrombocytopenia 3.22%, severe arrhythmia 3.2%, and hypersensitivity reaction 3.2%. In conclusion, paclitaxel with cisplatin as concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma is feasible, safe, and might improve regional control and survival rates in Chinese patients.     

Combined radiochemotherapy in locally advanced nasopharyngeal carcinoma

Background. Nasopharyngeal cancer (NPC) is a tumor of epidermoid origin with an entirely different biological behavior than other carcinoma of the head and neck region. Patients/methods. A retrospective analysis was performed in 93 cases with locally advanced NPC treated with induction chemotherapy followed by radiation therapy (RT; 79 patients) or concomitant RT and chemotherapy. Results. Totally 66 patients (71%) achieved a complete response (CR), 68% of the patients treated with induction chemotherapy followed by RT, 86% with concomitant chemoradiotherapy. After a median follow-up of 5.5 years 28 out of these 66 relapsed, 25 of them locoregionally. Median time to progression was 22.5 months, median overall survival (OS) 45 months, 5-year actuarial survival was 41.5%. Age, T and N classification, histological type and type of chemotherapy were independent significant factors for OS. Conclusions. Combined chemotherapy and RT in patients with locally advanced NPC result in a high CR rate. The main problem remains the locoregional control. Randomized studies are needed in order to define the optimal use of chemotherapy in combination with RT.     

The efficacy and safety of concurrent chemoradiotherapy for maxillary sinus squamous cell carcinoma patients

Objective

Combined treatment modality, e.g., definitive surgery followed by radiotherapy (RT) and definitive RT with concurrent chemotherapy, has been applied for advanced maxillary sinus squamous cell carcinoma (MSSCC) patients to obtain a better survival with organ preservation in Japan.

Methods

The outcome of 40 patients with MSSCC between 1991 and 2007 in our institute was analyzed retrospectively. There were 36 males and 4 females, the average age being 59.5 years (ranging from 34 to 81 years). The median follow-up time was 66.1 months. All the patients had received a combined treatment consisting of definitive surgery, RT, and intra-arterial or systemic chemotherapy. The chemotherapeutic regimen was different depending on the performance status and/or complications of the patients. Since 1998, concurrent chemoradiotherapy with cisplatin, 5-fluorouracil, methotrexate and leucovorin regimen (CCRT–PFML) instead of neo-adjuvant chemotherapy has been applied.

Results

The overall 5-year survival rate was 59.2%, the 5-year disease-specific survival rate was 71.7%, and the 5-year organ preservation survival rate was 42.4%. In the group receiving CCRT–PFML, the overall 5-year survival rate was 60.0%, the 5-year disease-specific survival rate was 76.0%, and the 5-year organ preservation survival rate was 60.3%.

Conclusion

CCRT–PFML for advanced MSSCC patients is feasible to preserve the organs without reducing the survival rate.     

Laryngeal preservation by treatment with induction chemotherapy and radiotherapy protocol for stage III & IV carcinoma larynx--results of a pilot study.

Total laryngectomy for advanced carcinoma of the larynx is effective but functionally disabling. In an effort at laryngeal preservation, 33 patients of stage III/IV carcinoma larynx were treated between 1987 and 1991 with induction chemotherapy followed by definitive radiation. Two chemotherapy protocols were administered. Group I patients received one to three cycles of cisplatin 100 mg/m2 (day 1), bleomycin 15 U/m2 (day 1), and 5-fluorouracil 1000 mg/m2/day (day 2 to 5) at three weekly intervals. This was then followed by radiotherapy. Group II received one to six weekly injections of single agent methotrexate 50 mg/m2 with or without leucocovorin rescue followed by radiotherapy. Any recurrence was salvaged by surgery. Midway through the study, Group II protocol was discontinued as the initial results were not comparable with Group I or standard treatment. The Group I protocol, however, yielded an initial locoregional control rate of 83.3 per cent With the addition of surgical salvage the locoregional control rate was 94.4 per cent and the control rate with laryngeal preservation was 88.8 per cent. The Kaplan-Meier probability of two years and five years disease-free survival was 81.9 per cent and 61.4 per cent respectively. For disease-free survival with laryngeal preservation the corresponding figures for two years and five years were 58.3 per cent and 41.7 per cent. The control group of 51 patients treated with radical surgery followed by radiotherapy yielded survival figures at two years and five years of 64.3 per cent and 57.2 per cent. The difference in the survival of Group I and the control group was not statistically significant (p value = 0.280). These initial results indicate that for stage III and for surgically resectable stage IV laryngeal carcinomas, a protocol of induction combination chemotherapy consisting of cisplatin, bleomycin and 5-fluorouracil followed by radiotherapy and combined with surgical salvage whenever required, can lead to comparable cure rates. In addition, a large proportion of patients are spared the morbidity of a total laryngectomy.     

A preliminary result of concurrent chemoradiation with weekly cisplatin in elderly nasopharyngeal carcinoma patients

CONCLUSION: A weekly regimen of cisplatin 30 mg/m2 as concurrent chemoradiation (CCRT) was effective in elderly nasopharyngeal carcinoma (NPC) patients, with acceptable and reversible acute toxicity following CCRT therapy. OBJECTIVES: The purpose of this retrospective study was to evaluate the efficacy, toxicity, and tolerability of a multi-modal treatment strategy in elderly NPC patients. Subsequent systemic adjuvant chemotherapy was administered to achieve systemic control. PATIENTS AND METHODS: From December 2002 to December 2006, 26 NPC patients over 60 years of age who had stage IIB to IV NPC were evaluated in this retrospective analysis. The CCRT chemotherapy protocol consisted of eight weekly doses of cisplatin 30 mg/m2 administered in an outpatient setting. Adjuvant systemic chemotherapy consisted of four monthly cycles of cisplatin (20 mg/m2/day) plus 5-fluorouracil (1000 mg/m2/day) for 5 consecutive days. Study end points included treatment outcome, compliance, and toxicity. RESULTS: The 2-year overall survival, disease-free survival, local control, and distant metastasis-free rate were 87%, 73%, 92%, and 76%, respectively. Over 80% of patients were able to take more than six doses of weekly cisplatin during CCRT; however, nearly half of the patients had grade 3 hematological toxicity during adjuvant therapy requiring treatment modification or cessation of further adjuvant therapy.     

Does Induction Chemotherapy Still Have a Role in Larynx Preservation Strategies? The Experience of Institut Catala d'Oncologia in Stage III Larynx Carcinoma

BACKGROUND: Radiotherapy with concurrent cisplatin is the standard alternative to total laryngectomy for patients with locally advanced laryngeal cancer. The value of induction chemotherapy in larynx-preservation therapies remains unknown. Hyperfractionation radiotherapy might improve disease-free survival. METHODS: From August 1993 to August 2004, 71 patients with T3N0-1 larynx tumors and eligible for total laryngectomy received induction chemotherapy with three cycles of cisplatin plus fluorouracil. Clinical tumor response was assessed by indirect laryngoscopy and computed tomography scan. Patients with complete response received hyperfractionation radiotherapy, whereas those without complete response were proposed for total laryngectomy. RESULTS: A total of 71 consecutive patients were included. Thirty-three patients achieved complete response to induction chemotherapy (46.5%), four of them presented a tumor relapse, and all underwent salvage surgery. Seventy-six percent of surviving patients preserved a functional larynx. Despite not achieving complete response, 15 patients refused total laryngectomy and received hyperfractionation radiotherapy. Seven patients presented a tumor relapse and salvage surgery was performed in three of them. Fifty percent of surviving patients preserved a functional larynx. Twenty-two patients without complete response underwent total laryngectomy; three of them presented a tumor relapse but none could be rescued. With a median follow up of 68 months, 5 five-year overall survival, 5-year disease-free survival, and 5-year larynx function preservation survival rates were 68% (confidence interval [CI], 57-80), 75% (CI, 64-87), and 42% (CI, 29-54), respectively. No differences in overall survival were observed between groups. Five-year disease-free survival of patients without complete response who received hyperfractionation radiotherapy was significantly lower than that of the other two groups (P < .02). Ten patients with larynx preservation and no tumor relapse had chronic toxicity that caused the loss of larynx function: seven patients required permanent tracheotomy, two died from pneumonia, and one patient died as a result of a laryngeal necrosis. CONCLUSIONS: Patients with complete response to induction chemotherapy in laryngeal carcinoma have a high probability of cure after hyperfractionation radiotherapy. However, hyperfractionation radiotherapy induces a high degree of toxicity that reduces the laryngeal function preservation rate and may jeopardize overall survival.     

局部晚期头颈部鳞状细胞癌的化疗及靶向进展

局部晚期头颈部鳞状细胞癌目前主要采用手术、放疗和化疗相结合的综合治疗,但是器官功能保留率和5年生存率没有显著提高。从20世纪70年代末开始,以顺铂为基础的化疗药开始应用于局部晚期头颈部鳞状细胞癌治疗中,研究表明,顺铂联合氟尿嘧啶作为诱导化疗方案提高了喉功能保全率。后来随着紫杉醇的应用,有研究证实在PF方案基础上加用紫杉醇可提高诱导化疗的疗效。与PF方案相比,TPF方案在局部控制率及无进展生存期上有显著的优越性,因此,成为诱导化疗的首选方案。20世纪90年代初期,同步放化疗成为非手术治疗及保喉的新方式,因其在总体生存率、保喉率、局部控制率上有明确的优势,已被列入局部晚期头颈部肿瘤非手术治疗的标准治疗方案。2006年分子靶向治疗药物西妥昔单抗经美国食品和药物管理局批准运用于临床,因其预后的优势及较少的不良反应成为无法耐受化疗药物的新选择。就局部晚期头颈部鳞状细胞癌的化疗药物及靶向药物治疗进展进行综述。     

Timing and duration of postoperative radiotherapy in patients with laryngeal cancer

Aim of this was an evaluation of the impact of prolongation of combined treatment time on the local-regional control laryngeal cancer patients treated with surgery and postoperative radiotherapy. Study was based on retrospective analysis of 254 patients with T3/T4 and N0-N2 laryngeal cancer who were treated between January 1993 and December 1996 with surgery and postoperative radiotherapy (RT). Median age of investigated group was 56.3 years. Surgery consisted of total laryngectomy in all cases and with selective neck dissection. RT began 22 to 78 days postoperatively (median 45 days) and continued for a median of 47 days (range, 40-74 days). The primary tumor bed and all lymph neck nodes were treated in all patients. The total dose to the primary tumor bed was about 60 Gy, fraction dose was 2 Gy. All lymph nodes were irradiated with a dose of 50 Gy. The factors studied for prognostic importance for a local-regional failure included: overall combined treatment time, interval between surgery and the start of radiotherapy, radiotherapy treatment time, age, sex, T and N categories. The 5-year actuarial disease-free local-regional survival was 50%. On univariate analysis, using log rank test, only N status, sex were predicted for the locoregional control of postoperative radiotherapy. Overall treatment time longer than 90 days and especially 100 days was correlated with worse locoregional results of combined treatment respectively (p = 0.003 and p = 0.0007). Also prolongation of interval time between surgery and postoperative radiotherapy beyond 50 days was connected with higher rate of failures (p = 0.02). The same trend was observed when time of irradiation was longer than 47 days (p = 0.01). This analysis indicated that the prolongation of the overall treatment time of combined modality, the the time between surgery, and radiotherapy and time of postoperative radiotherapy were correlated with increased of local regional failures.