進行喉頭下咽頭癌治療における化学放射線同時併用療法と拡大手術の選択 化学放射線同時併用療法の選択基準についての考察
進行喉頭・下咽頭癌の治療では，喉頭全摘術を伴う拡大切除術か化学放射線同時併用療法（CCRT）かの選択に悩むことが少なくない。CCRTで喉頭温存が可能となる症例をいかに推測できるかについて，対象を原発巣に対する治療法がCCRTを主体に治療した群と手術を主体に治療した群にわけ後ろ向きに検討した。その結果，今回の検討では腫瘍の大きさなどの臨床的因子からも，導入化学療法に対する反応という腫瘍生物学的因子からも推測は困難であった。また，無局所再発生存率，無領域再発生存率，疾患特異的生存率はCCRT主体群で58.2％，55.2％，30.2％，手術主体群でそれぞれ91.6％，76.4％，61.1％といずれも...
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| Published in | 頭頸部外科 Vol. 25; no. 3; pp. 275 - 282 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本頭頸部外科学会
28.02.2016
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1349-581X 1884-474X |
| DOI | 10.5106/jjshns.25.275 |
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| Abstract | 進行喉頭・下咽頭癌の治療では，喉頭全摘術を伴う拡大切除術か化学放射線同時併用療法（CCRT）かの選択に悩むことが少なくない。CCRTで喉頭温存が可能となる症例をいかに推測できるかについて，対象を原発巣に対する治療法がCCRTを主体に治療した群と手術を主体に治療した群にわけ後ろ向きに検討した。その結果，今回の検討では腫瘍の大きさなどの臨床的因子からも，導入化学療法に対する反応という腫瘍生物学的因子からも推測は困難であった。また，無局所再発生存率，無領域再発生存率，疾患特異的生存率はCCRT主体群で58.2％，55.2％，30.2％，手術主体群でそれぞれ91.6％，76.4％，61.1％といずれも手術主体群が有意に優れていた。 |
|---|---|
| AbstractList | 進行喉頭・下咽頭癌の治療では，喉頭全摘術を伴う拡大切除術か化学放射線同時併用療法（CCRT）かの選択に悩むことが少なくない。CCRTで喉頭温存が可能となる症例をいかに推測できるかについて，対象を原発巣に対する治療法がCCRTを主体に治療した群と手術を主体に治療した群にわけ後ろ向きに検討した。その結果，今回の検討では腫瘍の大きさなどの臨床的因子からも，導入化学療法に対する反応という腫瘍生物学的因子からも推測は困難であった。また，無局所再発生存率，無領域再発生存率，疾患特異的生存率はCCRT主体群で58.2％，55.2％，30.2％，手術主体群でそれぞれ91.6％，76.4％，61.1％といずれも手術主体群が有意に優れていた。 |
| Author | 別府, 武 白倉, 聡 藤川, 太郎 山田, 雅人 得丸, 貴夫 岡野, 渉 畑中, 章生 |
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| References | 18) Rudat V, Pfreundner L, Hoppe F, et al: Approaches to preserve larynx function in locally advanced laryngeal and hypopharyngeal cancer. Onkologie 27：368-375, 2004. 3) Stoeckli SJ, PawlikAb, Lipp M, et al: Salvage surgery after failure of nonsurgical therapy for carcinoma of the larynx and hypopharynx. Arch Otolaryngol Head Neck Surg 126：1473-1477, 2000. 16) Posner MR, Hershock DM, Blajman CR, et al: Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 357：1705-1715, 2007. 9) Mouw KW, Solanki AA, Stenson KM, et al: Performance and quality of life outcomes for T4 laryngeal cancer patients treated with induction chemotherapy followed by chemoradiotherapy. Oral Oncol 48：1025-1030, 2012. 13) Haddad R, O'Neil A, Rabinowits G, et al: Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol 14：257-264, 2013. 5) Forastiere AA, Goepfert H, Maor M, et al: Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349：2091-2098, 2003. 12) Paccagnella A, Ghi MG, Loreggian L, et al: Concomitant chemoradiotherapy versus induction docetaxel, cisplatin and 5 fluorouracil (TPF) followed by concomitant chemoradiotherapy in locally advanced head and neck cancer; a phase II randomized study. Ann Oncol 21：1515-1522, 2010. 14) Cohen EEZ, Karrison TG, Kocherginsky M, et al: Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer. J Clin Oncol 32：2735-2743, 2014. 4) 大月直樹，齋藤 幹，丹生健一：喉頭癌に対する化学放射線療法の役割．頭頸部外科，19：5-11，2009 6) Machtay M, Moughan J, Trotti A, et al: Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26：3582-3589, 2008. 7) Hutcheson KA, Lewin JS, Holsinger FC, et al: Long-term functional and survival outcomes after induction chemotherapy and risk-based definitive therapy for locally advanced squamous cell carcinoma of the head and neck. Head Neck 36：474-480, 2014. 10) Urba S, Wolf G, Eisbruch A, et al: Single-Cycle induction chemotherapy selects patients with advanced laryngeal cancer for combined chemoradiation: a new treatment paradigm. J Clin Oncol 24：593-598, 2006. 17) 米澤宏一郎，平山裕次，古川竜也，他：当科における高用量シスプラチンを用いた同時併用化学放射線療法の認容性に関する検討．頭頸部癌，40：362-365，2014 1) 日本頭頸部癌学会編：下咽頭癌，喉頭癌．頭頸部癌診療ガイドライン2009年度版，21-30，金原出版，東京，2009 11) Hanai N, Ozawa T, Hirakawa H, et al: The nodal response to chemoselection predicts the risk of recurrence following definitive chemoradiotherapy for pharyngeal cancer. Acta Otolaryngol 134：865-871, 2014. 2) Suzuki K, Hayashi R, Ebihara M, et al: The effectiveness of chemoradiation therapy and salvage surgery for hypopharyngeal squamous cell carcinoma. Jpn J Clin Oncol 43：1210-1217, 2013. 8) 大月直樹，四宮弘隆，小松弘和，他：進行期（stage III/IV）喉頭癌・下咽頭癌の治療戦略．頭頸部癌，40：406-411，2014 15) Gujral DM, Piercy D, Morden JP, et al: Current attitudes of head and neck oncologists in the United Kingdom to induction chemotherapy for locally advanced head and neck cancer: a survey of centres participating in a national randomised control trial. Oral Oncol 50：141-146, 2014. |
| References_xml | – reference: 8) 大月直樹，四宮弘隆，小松弘和，他：進行期（stage III/IV）喉頭癌・下咽頭癌の治療戦略．頭頸部癌，40：406-411，2014． – reference: 12) Paccagnella A, Ghi MG, Loreggian L, et al: Concomitant chemoradiotherapy versus induction docetaxel, cisplatin and 5 fluorouracil (TPF) followed by concomitant chemoradiotherapy in locally advanced head and neck cancer; a phase II randomized study. Ann Oncol 21：1515-1522, 2010. – reference: 6) Machtay M, Moughan J, Trotti A, et al: Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26：3582-3589, 2008. – reference: 9) Mouw KW, Solanki AA, Stenson KM, et al: Performance and quality of life outcomes for T4 laryngeal cancer patients treated with induction chemotherapy followed by chemoradiotherapy. Oral Oncol 48：1025-1030, 2012. – reference: 15) Gujral DM, Piercy D, Morden JP, et al: Current attitudes of head and neck oncologists in the United Kingdom to induction chemotherapy for locally advanced head and neck cancer: a survey of centres participating in a national randomised control trial. Oral Oncol 50：141-146, 2014. – reference: 10) Urba S, Wolf G, Eisbruch A, et al: Single-Cycle induction chemotherapy selects patients with advanced laryngeal cancer for combined chemoradiation: a new treatment paradigm. J Clin Oncol 24：593-598, 2006. – reference: 1) 日本頭頸部癌学会編：下咽頭癌，喉頭癌．頭頸部癌診療ガイドライン2009年度版，21-30，金原出版，東京，2009． – reference: 13) Haddad R, O'Neil A, Rabinowits G, et al: Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol 14：257-264, 2013. – reference: 7) Hutcheson KA, Lewin JS, Holsinger FC, et al: Long-term functional and survival outcomes after induction chemotherapy and risk-based definitive therapy for locally advanced squamous cell carcinoma of the head and neck. Head Neck 36：474-480, 2014. – reference: 14) Cohen EEZ, Karrison TG, Kocherginsky M, et al: Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer. J Clin Oncol 32：2735-2743, 2014. – reference: 17) 米澤宏一郎，平山裕次，古川竜也，他：当科における高用量シスプラチンを用いた同時併用化学放射線療法の認容性に関する検討．頭頸部癌，40：362-365，2014． – reference: 11) Hanai N, Ozawa T, Hirakawa H, et al: The nodal response to chemoselection predicts the risk of recurrence following definitive chemoradiotherapy for pharyngeal cancer. Acta Otolaryngol 134：865-871, 2014. – reference: 16) Posner MR, Hershock DM, Blajman CR, et al: Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 357：1705-1715, 2007. – reference: 18) Rudat V, Pfreundner L, Hoppe F, et al: Approaches to preserve larynx function in locally advanced laryngeal and hypopharyngeal cancer. Onkologie 27：368-375, 2004. – reference: 2) Suzuki K, Hayashi R, Ebihara M, et al: The effectiveness of chemoradiation therapy and salvage surgery for hypopharyngeal squamous cell carcinoma. Jpn J Clin Oncol 43：1210-1217, 2013. – reference: 3) Stoeckli SJ, PawlikAb, Lipp M, et al: Salvage surgery after failure of nonsurgical therapy for carcinoma of the larynx and hypopharynx. Arch Otolaryngol Head Neck Surg 126：1473-1477, 2000. – reference: 4) 大月直樹，齋藤 幹，丹生健一：喉頭癌に対する化学放射線療法の役割．頭頸部外科，19：5-11，2009． – reference: 5) Forastiere AA, Goepfert H, Maor M, et al: Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349：2091-2098, 2003. |
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| Snippet | 進行喉頭・下咽頭癌の治療では，喉頭全摘術を伴う拡大切除術か化学放射線同時併用療法（CCRT）かの選択に悩むことが少なくない。CCRTで喉頭温存が可能となる症例をいかに推... |
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| SubjectTerms | chemoselection 化学放射線同時併用療法 喉頭摘出を伴う拡大切除術 導入化学療法 進行喉頭・下咽頭癌 |
| Subtitle | 化学放射線同時併用療法の選択基準についての考察 |
| Title | 進行喉頭下咽頭癌治療における化学放射線同時併用療法と拡大手術の選択 |
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