頭頸部癌における導入化学療法

抄録

We carried out this study to clarify the treatment outcomes and problems associated with induction chemotherapy (using taxotere, cisplatin and 5-FU [TPF therapy]) in patients with hypopharyngeal or oropharyngeal cancer. The data of a total of 83 patients with hypopharyngeal cancer (including 14, 29, 23 and 17 patients with T1, T2, T3 and T4 disease, respectively, and 61, 13 and 9 patients with pyriform sinus (PS), posterior wall (PW) and postcricoid (PC) involvement) and oropharyngeal cancer (including 1, 7 and 25 patients with stage II, stage III and stage IV disease, respectively, and 26, 6 and 1 patients with side wall, front wall and upper wall involvement) were analyzed retrospectively. The main therapies employed in the patients with hypopharyngeal cancer were as follows: transoral surgical resection plus radiation therapy for T1 disease, radiation therapy, induction chemotherapy and partial resection for T2 disease, induction chemotherapy, radiation therapy and pharyngo-laryngoesophagectomy for T3 disease, and pharyngo-­laryngoesophagectomy plus induction chemotherapy for T4 disease. The 5-year larynx preservation rates in the patients with T1, T2, T3 and T4 disease were 100%, 73%, 39% and 35%, respectively. Our strategies yielded improved larynx preservation rates without adversely affecting the survival rates. However, the treatment method for T3 disease needs to be improved, because a large number of recurrences and deaths due to the primary disease were encountered in this patient group. The feasibility, incidence of neutropenia, response rate, and 3-year disease-specific survival rate in the induction chemotherapy group were 70%, 88%, 82% and 73%, respectively. A statistically significant difference in the 3-year disease-specific survival rate was seen between the p16-positive and p16-negative patients in the induction chemotherapy group: while the rate was 100% in the p16-positive patients, it was only 51% in the p16-negative patients (p = 0.004).