生存率と喉頭温存率からみた喉頭癌に対する治療方針の検討

抄録

A retrospective study was conducted to evaluate the clinical outcomes of 59 patients with laryngeal cancer treated at our department between 2001 and 2012 using our institution’s treatment protocol. The mean age of the patients, comprising 56 males and 3 females, was 70 years.
According to the TNM staging system, 39 cases (66.1%) were classified as having early-stage disease, and 20 (33.9%) as having advanced-stage disease. The treatment for early T stage laryngeal cancer at our insititution is radiation therapy at a total radiation dose of 60Gy. The patients with advanced-stage disease are treated by total laryngectomy with preoperative and postoperative radiation. The 5-year overall survival rate was 82.2% overall, being 92.4%, 100%, 72.9%, and 0% in patients with stage I, II, III, and IV disease, respectively. The disease-specific 5-year survival rate was 88.2% overall, being 100%, 83.3%, and 0% in patients with stage I/II, III, and IV disease, respectively. The preservation rate of the larynx was 85.3% in the T1 cases, but substantially lower (45.5%) in the T2 cases.
According to these results, our treatment protocol needs to be improved, particularly for patients with T2 and stage IV disease. Because the preservation rate of the larynx in the T2 cases was lower, we plan to introduce a new protocol involving the use of S-1 instead of 5-FU to improve the preservation rate of the larynx, or increase the total dose of radiation. Furthermore, we propose to add adjuvant systemic chemotherapy to the stage IV treatment protocol to improve the survival rate, because the high rate of distant metastasis was the main reason for the unsatisfactory results in patients with stage IV disease.