诱导化疗在局部晚期喉癌下咽癌治疗中的意义

Significance of induction chemotherapy in the treatment of locally advanced laryngeal cancer and hypopharyngeal cancer

目的：探讨诱导化疗在局部晚期喉癌、下咽癌治疗中的临床意义。方法：回顾性分析40例Ⅲ～Ⅳb期局部晚期喉癌、下咽癌患者，按照随机数字法，将40例患者分为治疗组与对照组各20例。治疗组采取3个周期诱导化疗后再评估行放疗或手术＋放疗，对照组采取手术＋放疗，观察比较2组的临床疗效、不良反应、生存率及保喉率，并随访5年。结果：治疗组均行诱导化疗，完全缓解3例（15％），部分缓解14例（70％），病情稳定2例（10％），病情进展1例（5％）。治疗有效17例（85％）。治疗组1年生存率优于对照组，差异有统计学意义（P〈0．05）；而3、5年生存率比较差异均无统计学意义（P〉0．05）。术后治疗组的保喉率为45％（9／20），而对照组仅为15％（3／20），二者比较差异有统计学意义（P〈0．05）。结论：诱导化疗的近期疗效值得肯定，能降低患者临床分期，减少肿瘤的微浸润，增加患者的手术机会与放疗机会，进而改善预后并提高生活质量。

Objective：To explore the effect of induction chemotherapy on the treatment of locally advanced laryngeal cancer and hypopharyngeal cancer. Method： A retrospective analysis of 40 cases with advanced laryngeal cancer or hypopharyngeal cancer at the stage of Ⅲ-Ⅳb. Forty patients were randomly divided into two groups： treatment group（receive induction chemotherapy before surgery plus radiation therapy） and control group （receive surgery plus radiotherapy）. During a five years follow-up, the therapeutic effect, the adverse treatment reactions, the survival rate and the larynx preservation rate were analyzed and compare between the two groups. Result： Twenty patients in the treatment group all received induction chemotherapy. After treatment, 3 patients with complete remission（CR）, 14 patients with partial response（PR）,2 patients in stable condition, and 1 patient with progression disease. The effective number of the treatment patients was 17 in the treatment group. The one-year survival rate in the treatment group was higher than that in the control group（P〈0.05）,however, the 3-year and 5-year survival rate were similar in the two groups（P〉0.05）. The arynx preservation rate in the treatment and control group was 45 % （9/20）and 15% （3/20）,respectivelyl and there was significant difference between the two groups（P〈0.05）. Conclusion： The Induction of chemotherapy has a better short-term curative effect, which can alleviate clinical staging of the cancer, reduce tumor micro infiltration, increase the chance of patients with surgical opportunity and radiation therapy, and ultimately improve the outcome after treatment.