臨床
Stage IVA頭頸部癌N2頸部リンパ節転移に対する術前化学放射線同時療法と頸部郭清術の有効性の評価
2019 年 112 巻 3 号 p. 181-188
詳細
2019 年 112 巻 3 号 p. 181-188
The necessity of planned neck dissection (PND) after definitive concurrent chemoradiotherapy (CCRT) is still controversial, because of the rapid progression of image-guided surveillance for advanced nodal disease using PET-CT. But definitive CCRT with PND has been reported to be associated with severe long-term adverse effects.
At our hospital, since 2006, we have been treating head and neck squamous cell cancer patients with N2 nodal disease by ND after preoperative CCRT administered at a median dose of 46 Gy. The reduced-dose CCRT was aimed at avoiding severe adverse events while preserving the efficacy.
In this study, 34 cases with stage IVA head and neck squamous cell cancer patients (including 16 cases of hypopharyngeal carcinoma, 11 of oropharyngeal carcinoma, and 7 of laryngeal carcinoma) were enrolled, and the efficacy of our therapeutic paradigm was analyzed, along with evaluation of the necessity of preoperative CCRT followed by ND.
The results were as follows: the 3-year disease-specific survival rate (DSS) was 86%, the 3-year cervical recurrence-free rate was 90%, and the rate of finding pathological nests of viable cancer cells in the dissected lymph nodes was 47%. In regard to the stage of nodal disease, 0% had N2a disease, 50% had N2b disease, and 46% had N2c disease. The rates in the hypopharyngeal or laryngeal carcinoma patients were higher than those in the oropharyngeal carcinoma patients.
Furthermore, the 3-year DSS in the group without viable cancer cells in the dissected lymph nodes was found to be significantly higher than that in the group with viable cells in the dissected lymph nodes. There were no cases with any severe adverse events, such as cases needing permanent tracheostomy or gastrostomy. The data did not show any inferiority as compared to previous reports, although it is noteworthy that viable cancer cells could be identified in 47% of the dissected lymph nodes.
To conclude, our recommended therapeutic approach for N2 neck nodal disease in patients with head and neck squamous cell cancer would still be comprehensive preoperative CCRT with reduced-dose irradiation followed by adequate ND.
