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異なる治療法を用いた T2N0M0 喉頭扁平上皮癌の長期治療成績の比較
Comparison of long-term treatment outcomes of T2N0M0 laryngeal squamous cell carcinoma using different treatment methods.
PMID: 32566021 PMCID: PMC7285832. DOI: 10.3892/ol.2020.11628.
抄録
早期の[I期およびII期（T2N0M0）]喉頭がんは、現在のところ、確定的放射線療法または喉頭温存手術からなる単一の方法で治療することが推奨されている。I期の治療成績は良好であるが、T2N0M0になると成功する頻度が低下する。そこで本研究では，T2N0M0 喉頭癌における治療法の違いによる治療成績を検討した。合計 83 例の未治療 T2N0M0 喉頭扁平上皮癌患者が登録された。患者は治療法によってグループ分けされた。放射線療法（RT：27人）、シスプラチンをベースとした化学放射線療法（CRT：46人）、手術をベースとした治療（SBT：10人）に分けた。再発率はRT群44.4％、CRT群19.6％、SBT群50％であった。さらに、RT群、CRT群、SBT群の局所コントロール率はそれぞれ55.6、87.0、80％であった。CRT群はRT群に比べて再発率が有意に低く、局所制御率が高かった（P＜0.05）。生存解析では、全生存率と疾患特異的生存率は治療群間で有意差はなかった。しかし、3年・5年無病生存率（DFS）はRT群がいずれも55％、SBT群がいずれも50％、CRT群がいずれも80％であった。さらに、CRT群は他の群と比較して有意に高いDFSを示した（P=0.02）。Cox回帰を用いた多変量解析により、治療法がDFSの最も重要な因子であり、CRT群で有意な影響を与えていることが明らかになった。また、前連接部と喉頭蓋下浸潤を有する喉頭蓋がん患者では、CRT群はRT群に比べてDFSが有意に改善したが、喉頭蓋下浸潤を有しない患者では両群間に有意差はなかった。National Cancer Institution Common Toxicity Criteria（バージョン5.0）によると、CRT群ではRT群に比べて毒性を有する患者が多かった。しかし、RT群とCRT群では、毒性による死亡例はなく、治療関連の毒性は管理可能であった。このレトロスペクティブ研究の限界から、決定的な結論は得られなかったが、この結果をまとめると、T2N0M0喉頭癌患者において、CRTは管理可能な毒性を有し、局所コントロールおよびDFS率に好影響を与えたことが示唆される。
Early [stage I and II (T2N0M0)] laryngeal cancer types are currently recommended to be treated with a single modality, consisting of definitive radiation therapy or larynx-preserving surgery. Although the treatment outcomes of stage I are good, the frequency of successful outcomes decreases with T2N0M0. Therefore, the present study investigated the treatment outcomes of different treatment methods in T2N0M0 laryngeal cancer. In total, 83 patients with previously untreated T2N0M0 laryngeal squamous cell carcinoma were enrolled. Patients were grouped by treatment method: Radiation therapy (RT; 27 patients); chemoradiotherapy (CRT; 46 patients) with cisplatin base; and surgery-based therapy (SBT; ten patients). The recurrence rates of the RT, CRT and SBT groups were 44.4, 19.6 and 50%, respectively. Moreover, the local control rates of the RT, CRT and SBT groups were 55.6, 87.0 and 80%, respectively. The CRT group had a significantly lower recurrence rate and higher local control rate compared with the RT group (P<0.05). In the survival analysis, overall and disease-specific survival rate did not differ significantly among the treatment groups. However, 3- and 5-year disease-free survival rates (DFS) of the RT group were both 55%, those of the SBT group were both 50% and those of the CRT group were both 80%. Furthermore, the DFS was significantly higher in CRT group compared with the other groups (P=0.02). Using multivariate analysis with Cox regression, it was found that the treatment method was the most important factor for DFS and had a significant impact in the CRT group. In addition, in patients with glottic cancer with anterior commissure and subglottic invasion, the CRT group had significantly improved DFS compared with the RT group, whereas there was no significant difference between the two groups in patients without subglottic invasion. According to National Cancer Institution Common Toxicity Criteria (version 5.0), more patients had toxicity in the CRT group compared with the RT group. However, in the RT and CRT groups, no patients demonstrated mortality due to toxicity, and treatment-related toxicities were manageable. Collectively, although definitive conclusions could not be established, due to the limitations of this retrospective study, the results suggest that CRT had a positive impact on the local control and DFS rates with manageable toxicity in patients with T2N0M0 laryngeal cancer.
Copyright © 2020, Spandidos Publications.