新辅助化疗生物选择在 T4 喉癌患者器官保存中的效用。
Utility of bioselection with neoadjuvant chemotherapy for organ preservation in patients with T4 laryngeal cancer.
发表日期：2024 Jun 28
作者：
William J Benjamin, Allen L Feng, Molly Heft Neal, Emily Bellile, Keith A Casper, Kelly M Malloy, Andrew J Rosko, Chaz L Stucken, Mark E Prince, Michelle L Mierzwa, Jeremy M G Taylor, Avraham Eisbruch, Matthew E Spector, Gregory T Wolf, Paul L Swiecicki, Francis P Worden, Steven B Chinn
来源：
ORAL ONCOLOGY
摘要：
用于诱导选择确定性治疗 (IS) 方案的新辅助化疗在 T3 喉鳞状细胞癌 (LSCC) 患者的器官保存和生存方面显示出良好的结果。我们寻求评估接受 IS 方案治疗的 T4 LSCC 患者的生存和器官保存结果。根据保留功能性喉的潜力，接受 IS 方案的晚期 T3 和 T4 LSCC 患者的回顾性队列。患者接受一个新辅助周期的含 5-氟尿嘧啶或多西他赛的铂类化疗，或接受两个周期的含多西他赛和 Bcl-2 抑制剂的铂类化疗。通过放射学检查和/或内窥镜评估确定达到 ≥ 50% 缓解的患者接受了明确的放化疗。 IS 后缓解率 < 50% 的患者接受全喉切除术 (TL)，随后进行术后放疗/化疗。在 T4 患者中，114 例符合纳入标准，其中 89 例接受 IS 方案，25 例接受前期 TL。总共，76.0% 的 T3 患者和 71.9% 的 T4 患者对 IS 有反应并接受了明确的放化疗。 T4 IS 和 T4 TL 患者的死亡风险没有显着差异（HR：0.9，p = 0.86）。在应答者中，5 年无喉切除术生存率（T3 - 59.6%，T4 44.3%，p = 0.15）或按 T 分期保留喉部（T3 - 72.8%，T4 - 73.0%，p = 0.84）没有显着差异)。选择 T4 患者可能会受益于使用 IS 方案的器官保存，与 T3 肿瘤患者的反应率相似，与前期 TL 相比，不会影响生存。版权所有 © 2024 Elsevier Ltd. 保留所有权利。
Neoadjuvant chemotherapy for induction selection of definitive treatment (IS) protocols have shown excellent outcomes for organ preservation and survival in patients with T3 laryngeal squamous cell carcinoma (LSCC). We seek to evaluate survival and organ preservation outcomes in T4 LSCC patients treated with IS protocols.Retrospective cohort of advanced T3 and T4 LSCC patients who underwent IS protocols based upon potential for preserving a functional larynx. Patients received one neoadjuvant cycle of platinum-based chemotherapy with either 5-fluorouracil or docetaxel or with two cycles of platinum-based chemotherapy with docetaxel and a Bcl-2 inhibitor. Patients who achieved ≥ 50 % response as determined by radiographic review and/or endoscopic evaluation received definitive chemoradiation. Patients who had < 50 % response after IS underwent total laryngectomy (TL) followed by post-operative radiation +/- chemotherapy.Amongst T4 patients, 114 met inclusion criteria including 89 who underwent IS protocols and 25 who received an upfront TL. In total, 76.0 % of T3 patients and 71.9 % of T4 patients responded to IS and underwent definitive chemoradiation. There was no significant difference in hazard of death between T4 IS and T4 TL patients (HR: 0.9, p = 0.86). Among responders, there was no significant difference in 5-year laryngectomy-free survival (T3 - 59.6 %, T4 44.3 %, p = 0.15) or laryngeal preservation by T stage (T3 - 72.8 %, T4 - 73.0 %, p = 0.84).Select T4 patients may benefit from organ preservation using IS protocols with similar response rates to patients with T3 tumors, without compromising survival when compared to upfront TL.Copyright © 2024 Elsevier Ltd. All rights reserved.