非手术综合治疗保留中晚期喉癌患者喉器官的效果分析

Effective analysis of non-surgical combined treatments for laryngeal organ preservation in locally advanced laryngeal carcinoma

目的 评估应用非手术综合治疗方法治疗中晚期喉癌患者的治疗效果.方法 回顾性分析2007年11月至2015年4月,解放军总医院耳鼻咽喉头颈外科46例应用非手术综合治疗方法治疗有强烈保喉意愿或手术难以切除的局部中晚期喉癌患者的病例资料.采用同步放化疗[＆#177;表皮生长因子受体（EGFR）分子靶向治疗]、诱导化疗后同步放化疗（＆#177;EGFR分子靶向治疗）及放疗联合EGFR分子靶向治疗的治疗方法.放疗总剂量60～ 70 Gy.总生存率采用Kaplan-Meier方法计算.应用不良事件通用术语标准第3版评估不良反应.结果 患者随访6 ～ 95个月,平均随访时间31.8个月.所有患者完成了计划的放疗周期,45例（97.8％）患者完成了计划的化疗周期.患者3年、5年的总生存率分别为87.3％、67.2％;5年喉器官保留率为100.0％;3年、5年的无进展生存率分别为95.1％、87.7％.所有患者均能承受治疗中的不良反应,治疗中最常见的急性不良反应为3级口咽腔黏膜炎.在治疗结束后有2例声门型喉癌患者气管切开后未拔管.无患者出现明显的发音障碍,无患者进行胃造口术.结论 通过非手术综合治疗方法可保留喉癌患者的喉器官,患者获得了较高的喉器官保留率和较小的不良反应,提高了喉癌患者的生活质量.

Objective To evaluate the therapeutic effects,larynx preservation and adverse events of non-surgical combined treatments for laryngeal organ preservation in locally advanced laryngeal squamous cell carcinomas（SCCs）.Methods Forty-six patients with locally advanced laryngeal carcinoma （T2-4,N0-N3） were treated individually with non-surgical combined treatments for larynx preservation （LP）.These treatments included concurrent chemoradiotherapy （CCRT） （＆#177; epidermal growth factor receptor （EGFR）inhibitor）,induction chemotherapy （ICT） followed by CCRT （＆#177; EGFR inhibitor）,or concurrent radiotherapy and EGFR inhibitor.Radiation therapy was given to a total dose of 60-70 Gy.The KaplanMeier method was used to determine the overall survival.Side-effects were evaluated with the established Common Terminology Criteria for Adverse Events （CTCAE） version 3.0 criteria.Results The average follow-up time was 31.8 months （range 6-95 months）.All patients completed the planned radiotherapywithout treatment breaks,and 45（97.8%） of 46 patients completed the planned chemotherapy.The 3-year and 5-year overall survival rates were 87.3% and 67.2%,respectively.The 5-year larynx preservation rate was 100.0%.The 3-year and 5-year progression free survival rates were 95.1% and 87.7%,respectively.The most common acute side effect in grade 3 was oropharyngeal mucositis.After treatment,tracheotomy was still required in 2 patients with glottis cancer for laryngeal edema or stenosis.No patient depended on a percutaneous gastrostomy and experienced speech impairment.Conclusion Patients with locally advanced laryngeal cancer can be offered non-surgical combined treatments for laryngeal preservation and the high quality of life,showing a higher laryngeal preservation survival rate with minimal toxicities.