Postoperative Radiotherapy for High-risk Laryngeal or Hypopharyngeal Squamous Cell Carcinoma
L Kropp, R Dagan, CG Morris, C Bryant, JW Werning, P Dziegielewski, WM Mendenhall, RJ Amdur
Hong Kong J Radiol 2017;20:110-4
DOI: 10.12809/hkjr1715373
Objectives: To review the outcome of patients with positive / close margins and / or extracapsular extension (ECE) of lymph nodes who underwent radiotherapy (RT) with or without chemotherapy following radical surgery for laryngeal or hypopharyngeal squamous cell carcinoma, and to determine the factors associated with poor prognosis.
Methods: We retrospectively reviewed the records of patients with positive / close margins and / or ECE who underwent RT with or without chemotherapy following radical surgery for laryngeal or hypopharyngeal squamous cell carcinoma.
Results: In 70 men and 15 women aged 40 to 82 years, their primary lesions were graded as stage III (n = 6), IVA (n = 61), or IVB (n = 18). 73% of patients had either ECE (29%) or a high-risk margin (44%), and 27% of patients had both. The median RT dose was 64 (range, 54-76) Gy. The median follow-up periods for all patients and living patients were 2.5 and 4.0 years, respectively. The median times to locoregional failure and distant failure were 1.0 and 0.8 years, respectively. The 5-year rates for locoregional control, distant metastasis-free survival, disease-free survival, cause-specific survival, and overall survival were 72%, 69%, 47%, 52%, and 35%, respectively. These 5-year rates were poorer in patients with both ECE and positive / close margins than in those with one high-risk feature only (50% vs. 79%, 50% vs. 77%, 19% vs. 60%, 18% vs. 66%, and 16% vs. 42%, respectively). The presence of ECE consistently resulted in poorer 5-year outcomes. Patients with more pathologic features had poorer 5-year outcomes. 23 patients developed acute or late complications of grade 3 or higher. Two patients had grade-5 toxicity; one died during hospitalisation after surgery for an oesophageal perforation and the other had multiple organ failure.
Conclusion: In patients with positive / close margins and / or ECE, postoperative RT reduced the risk of recurrence. Patients with both high-risk pathologic features are at a higher risk of locoregional and distant failures and should undergo aggressive adjuvant or innovative treatment.
Authors’ affiliations:
L Kropp, R Dagan, CG Morris, C Bryant, WM Mendenhall, RJ Amdur: Department of Radiation Oncology, University of Florida, Florida, USA
JW Werning, P Dziegielewski: Department of Otolaryngology, University of Florida, Florida, USA
中文摘要
術後放射治療高危喉癌和下嚥癌
L Kropp, R Dagan, CG Morris, C Bryant, JW Werning, P Dziegielewski, WM Mendenhall, RJ Amdur
目的：回顧喉或下嚥鱗狀細胞癌患者接受根治手術治療後，放療（RT）加或不加化療治療切緣陽性 / 近和 / 或淋巴結包膜外侵（ECE）的療效，並確定預後不良因素。
方法：回顧性分析喉或下嚥鱗狀細胞癌患者接受根治手術治療後，RT加或不加化療治療切緣陽性 / 近和 / 或ECE的療效。
結果：70例男性15例女性年齡介於40至82歲其原發病變分期為III期（n = 6）、IVA期（n = 61）或IVB期（n = 18）。73%的患者有ECE（29%）或高危切緣（44%），27%的患者兩者皆有。中位RT劑量為64（範圍54-76）Gy。所有和仍活著患者的中位隨診時間分別為2.5和4.0年。局部區域失敗和遠處失敗的中位時間分別為1.0和0.8年。5年的局部區域控制率、遠處無轉移生存率、無病生存率、原因特異性存活率和總生存率依次為72%、69%、47%、52%和35%。有ECE和切緣陽性 / 近的患者比僅有一個高風險特徵的患者的以上提及的5年率更差（50%對79%、50%對77%、19%對60%、18%對66%、16%對42%）。有ECE導致較差的5年期結果。有較多病理特徵的患者5年期結果較差。23例患者出現3級以上急性或晚期併發症。兩名患者有5級毒性；一名因食管穿孔死亡，另一名因多器官衰竭死亡。
結論：對於切緣陽性 / 近和 / 或ECE的患者，術後RT可降低復發的風險。有高風險病理特徵的患者有較高局部區域和遠處失敗的風險，故應進行積極的輔助或創新治療。