頭頸部扁平上皮癌に対する化学療法併用放射線治療後の頸部転移リンパ節の評価
背景: 化学療法併用放射線治療 (CCRT) が頭頸部扁平上皮癌 (HNSCC) 進行例に対し施行される機会が増えている. 頸部リンパ節の制御は予後に関与するため CCRT 後の治療効果判定は救済手術の判断に重要な役割を担う. 患者と方法: 頸部リンパ節転移を有する HNSCC 症例に対し CCRT 施行後, 4~8週間後に画像検査および細胞診を施行し CR 群と no-CR 群に2分し治療終了6カ月後の臨床経過と比較することで検査精度を評価した. 結果: 感度, 特異度, 陽性的中率, 陰性的中率, 精度はそれぞれ CT・MRI で66.7%, 73.5%, 26.7%, 93.8%,...
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Published in | 日本耳鼻咽喉科学会会報 Vol. 117; no. 7; pp. 899 - 906 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | Japanese |
Published |
一般社団法人 日本耳鼻咽喉科学会
20.07.2014
日本耳鼻咽喉科学会 |
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Online Access | Get full text |
ISSN | 0030-6622 1883-0854 |
DOI | 10.3950/jibiinkoka.117.899 |
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Abstract | 背景: 化学療法併用放射線治療 (CCRT) が頭頸部扁平上皮癌 (HNSCC) 進行例に対し施行される機会が増えている. 頸部リンパ節の制御は予後に関与するため CCRT 後の治療効果判定は救済手術の判断に重要な役割を担う. 患者と方法: 頸部リンパ節転移を有する HNSCC 症例に対し CCRT 施行後, 4~8週間後に画像検査および細胞診を施行し CR 群と no-CR 群に2分し治療終了6カ月後の臨床経過と比較することで検査精度を評価した. 結果: 感度, 特異度, 陽性的中率, 陰性的中率, 精度はそれぞれ CT・MRI で66.7%, 73.5%, 26.7%, 93.8%, 72.5%, 頸部超音波検査 (US) で91.7%, 69.9%, 30.6%, 98.3%, 72.6%, FDG-PET/PET-CT で50.0%, 96.4%, 66.7%, 93.0%, 90.5%, 細胞診で68.4%, 96.1%, 81.3%, 92.5%, 90.6%であった. 考察: CCRT 後の頸部リンパ節転移への治療効果判定には US が陽性スクリーニングとして, FDG-PET/PET-CT が陰性スクリーニングとして有用であった. これらの検査結果が臨床経過と乖離した場合は高精度検査である細胞診を併用し診断能力の向上が可能と考えられた. |
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AbstractList | 「背景」 : 化学療法併用放射線治療 (CCRT) が頭頸部扁平上皮癌 (HNSCC) 進行例に対し施行される機会が増えている. 頸部リンパ節の制御は予後に関与するためCCRT後の治療効果判定は救済手術の判断に重要な役割を担う. 「患者と方法」 : 頸部リンパ節転移を有するHNSCC症例に対しCCRT施行後, 4~8週間後に画像検査および細胞診を施行しCR群とno-CR群に2分し治療終了6ヵ月後の臨床経過と比較することで検査精度を評価した. 「結果」 : 感度, 特異度, 陽性的中率, 陰性的中率, 精度はそれぞれCT・MRIで66.7%, 73.5%, 26.7%, 93.8%, 72.5%, 頸部超音波検査 (US) で91.7%, 69.9%, 30.6%, 98.3%, 72.6%, FDG-PET/PET-CTで50.0%, 96.4%, 66.7%, 93.0%, 90.5%, 細胞診で68.4%, 96.1%, 81.3%, 92.5%, 90.6%であった. 「考察」 : CCRT後の頸部リンパ節転移への治療効果判定にはUSが陽性スクリーニングとして, FDG-PET/PET-CTが陰性スクリーニングとして有用であった. これらの検査結果が臨床経過と乖離した場合は高精度検査である細胞診を併用し診断能力の向上が可能と考えられた. 背景: 化学療法併用放射線治療 (CCRT) が頭頸部扁平上皮癌 (HNSCC) 進行例に対し施行される機会が増えている. 頸部リンパ節の制御は予後に関与するため CCRT 後の治療効果判定は救済手術の判断に重要な役割を担う. 患者と方法: 頸部リンパ節転移を有する HNSCC 症例に対し CCRT 施行後, 4~8週間後に画像検査および細胞診を施行し CR 群と no-CR 群に2分し治療終了6カ月後の臨床経過と比較することで検査精度を評価した. 結果: 感度, 特異度, 陽性的中率, 陰性的中率, 精度はそれぞれ CT・MRI で66.7%, 73.5%, 26.7%, 93.8%, 72.5%, 頸部超音波検査 (US) で91.7%, 69.9%, 30.6%, 98.3%, 72.6%, FDG-PET/PET-CT で50.0%, 96.4%, 66.7%, 93.0%, 90.5%, 細胞診で68.4%, 96.1%, 81.3%, 92.5%, 90.6%であった. 考察: CCRT 後の頸部リンパ節転移への治療効果判定には US が陽性スクリーニングとして, FDG-PET/PET-CT が陰性スクリーニングとして有用であった. これらの検査結果が臨床経過と乖離した場合は高精度検査である細胞診を併用し診断能力の向上が可能と考えられた. |
Author | 荒井, 康裕 澤熊, 香衣 小松, 正規 田口, 享秀 田中, 恭子 高橋, 優宏 佐久間, 直子 高橋, 秀聡 西村, 剛志 佐野, 大佑 折舘, 伸彦 |
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References | 4) Budach V, Stuschke M, Budach W, et al: Hyperfractionated accelerated chemoradiation with concurrecnt fluorouracil-mitomycin is more effective than dose-escalated hyperfractionated accelerated radiation therapy alone in locally advanced head and neck cancer: final results of the radiotherapy cooperative clinical trials group of the German Cancer Society 95-06 Prospective Randomized Trial. J Clin Oncol 2005; 23: 1125-1135. 5) Jermic B, Shibamoto Y, Milicic B, et al: Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. J Clin Oncol 2000; 18: 1458-1464. 31) Gourin CG, Williams HT, Seabolt WN, et al: Utility of positron-emission tomography-computed tomography in identification of residual nodal disease after chemoradiation for advanced head and neck cancer. Laryngoscope 2006; 116: 705-710. 21) Schöder H, Fury M, Lee N, et al: PET monitoring of therapy response in head and neck squamous cell carcinoma. J Nucl Med 2009; 50: 74S-88S. 10) Fujii M, Tsukuda M, Satake B, et al: Phase I/II trial of weekly docetaxel and concomitant radiotherapy for squamous cell carcinoma of the head and neck. Int J Clin Oncol 2004; 9: 107-112. 15) Tsukuda M, Ishitoya J, Matsuda H, et al: Randomized controlled phase II comparison study of concurrent chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil versus CCRT with cisplatin, 5-fluorouracil, methotrexate and leucovorin in patients with locally advanced squamous cell carcinoma of the head and neck. Cancer Chemother Pharmacol 2010; 66: 729-736. 17) Furukawa MK, Furukawa M: Diagnosis of lymph node metastases of head and neck cancer and evaluation of effect of chemoradiotherapy using ultrasonography. Int J Clin Oncol 2010; 15: 23-32. 18) Horiuchi C, Taguchi T, Yoshida T, et al: Early assessment of clinical response to concurrent chemoradiotherapy in head and neck carcinoma using fluoro-2-deoxy-D-glucose positron emission tomography. Auris Nasus Larynx 2008; 35: 103-108. 1) Forastiere AA, Maor M, Weber RS, et al: Long-term results of Intergroup RTOG 91-11: a phase III trial to preserve the larynx-induction cisplatin/5-FU and radiation therapy versus concurrent cisplatin and radiation therapy versus radiation therapy [abstract]. J Clin Oncol 2006; 24: 18s. Abstract 5517. 26) Corry J, Peters L, Fisher R, et al: N2-N3 neck nodal control without planned neck dissection for clinical/radiologic complete responders-results of Trans Tasman Radiation Oncology Group Study 98. 02. Head Neck 2008; 30: 737-742. 23) Brizel DM, Prosnitz RG, Hunter S, et al: Necessity for adjuvant neck dissection in setting of concurrent chemoradiation for advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2004; 58: 1418-1423. 27) Peters LJ, Weber RS, Morrison WH, et al: Neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy. Head Neck 1996; 18: 552-559. 3) Brizel DM, Albers ME, Fisher SR, et al: Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998; 338: 1798-1804. 16) Eisenhauer EA, Therasse P, Bogaerts J, et al: New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-247. 11) Taguchi T, Tsukuda M, Mikami Y, et al: Concurrent chemoradiotherapy with cisplatin, 5-fluorouracil, methotrexate, and leucovorin in patients with advanced resectable squamous cell carcinoma of the larynx and hypopharynx. Acta Otolaryngol 2006; 126: 408-413. 19) Pignon JP, Bourhis J, Domenge C, et al: Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data; MACH-NC Collaborative Group; Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 2000; 355: 949-955. 24) Argiris A, Stenson KM, Brockstein BE, et al: Neck dissection in the combined-modality therapy of patients with locoregionally advanced head and neck cancer. Head Neck 2004; 26: 447-455. 2) Domange C, Hill C, Lefebvre JL, et al: Randomized trial of neoadjuvant chemotherapy in oropharyngeal carcinoma. French Groupe d'Etude des Tumeurs de la Tere et du Cou (GETTEC). Br J Cancer 2000; 83: 1594-1598. 7) Calais G, Alfonsi M, Bardet E, et al: Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst 1999; 91: 2081-2086. 9) Katori H, Tsukuda M, Mochimatsu I, et al: Phase I trial of concurrent chemoradiotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with locally advanced squamous cell carcinoma of head and neck (SCCHN). Br J Cancer 2004; 90: 348-352. 14) Tsukuda M, Ishitoya J, Mikami Y, et al: Analysis of feasibility and toxicity of concurrent chemoradiotherapy with S-1 for locally advanced squamous cell carcinoma of the head and neck in elderly cases and/or cases with comorbidity. Cancer Chemother Pharmacol 2009; 64: 945-952. 6) Bonner JA, Harari PM, Giralt J, et al: Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006; 354: 567-578. 20) Adelstein DJ, Li Y, Adams GL, et al: An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 2003; 21: 92-98. 30) Yousem DM, Som PM, Hackney DB, et al: Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes; MR imaging versus CT. Radiology 1992; 182: 753-759. 12) Katori H, Tsukuda M, Taguchi T: Analysis of efficacy and toxicity of chemotherapy with cisplatin, 5-fluorouracil, methotrexate and leucovorin (PFML) and radiotherapy in the treatment of locally advanced squamous cell carcinoma of the head and neck. Cancer Chemother Pharmacol 2007; 59: 789-794. 13) Katori H, Tsukuda M, Taguchi T: Concurrent chemoradiotherapy with carboplatin and uracil-tegafur (UFT) for patients with poor performance status with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Acta Otolaryngol 2007; 127: 1099-1104. 29) Som PM: Detection of metastasis in cervical lymph node; CT and MR criteria and differential diagnosis. AJR Am J Roentgenol 1992; 158: 961-969. 8) Taguchi T, Ikeda Y, Mikami Y, et al: Combined radiotherapy and chemotherapy with carboplatin and UFT for head and neck squamous cell carcinoma. Anticancer Res 2003; 23: 713-717. 25) Lavertu P, Adelstein DJ, Saxton JP, et al: Management if the neck in a randomized trial comparing concurrent chemotherapy and radiotherapy with radiotherapy alone in resectable stage III and IV squamous cell head and neck cancer. Head Neck 1997; 19: 559-566. 28) Ong SC, Schöder H, Lee NY, et al: Clinical utility of 18F-FDG PET/CT in assessing the neck after concurrent chemoradiotherapy for locoregional advanced head and neck cancer. J Nucl Med 2008; 49: 532-540. 22) Parsons JT, Mendenhall WM, Stringer SP, et al: Squamous cell carcinoma of the oropharynx; surgery, radiation therapy, or both. Cancer 2002; 94: 2967-2980. |
References_xml | – reference: 18) Horiuchi C, Taguchi T, Yoshida T, et al: Early assessment of clinical response to concurrent chemoradiotherapy in head and neck carcinoma using fluoro-2-deoxy-D-glucose positron emission tomography. Auris Nasus Larynx 2008; 35: 103-108. – reference: 19) Pignon JP, Bourhis J, Domenge C, et al: Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data; MACH-NC Collaborative Group; Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 2000; 355: 949-955. – reference: 26) Corry J, Peters L, Fisher R, et al: N2-N3 neck nodal control without planned neck dissection for clinical/radiologic complete responders-results of Trans Tasman Radiation Oncology Group Study 98. 02. Head Neck 2008; 30: 737-742. – reference: 27) Peters LJ, Weber RS, Morrison WH, et al: Neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy. Head Neck 1996; 18: 552-559. – reference: 30) Yousem DM, Som PM, Hackney DB, et al: Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes; MR imaging versus CT. Radiology 1992; 182: 753-759. – reference: 9) Katori H, Tsukuda M, Mochimatsu I, et al: Phase I trial of concurrent chemoradiotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with locally advanced squamous cell carcinoma of head and neck (SCCHN). Br J Cancer 2004; 90: 348-352. – reference: 29) Som PM: Detection of metastasis in cervical lymph node; CT and MR criteria and differential diagnosis. AJR Am J Roentgenol 1992; 158: 961-969. – reference: 16) Eisenhauer EA, Therasse P, Bogaerts J, et al: New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009; 45: 228-247. – reference: 11) Taguchi T, Tsukuda M, Mikami Y, et al: Concurrent chemoradiotherapy with cisplatin, 5-fluorouracil, methotrexate, and leucovorin in patients with advanced resectable squamous cell carcinoma of the larynx and hypopharynx. Acta Otolaryngol 2006; 126: 408-413. – reference: 23) Brizel DM, Prosnitz RG, Hunter S, et al: Necessity for adjuvant neck dissection in setting of concurrent chemoradiation for advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2004; 58: 1418-1423. – reference: 14) Tsukuda M, Ishitoya J, Mikami Y, et al: Analysis of feasibility and toxicity of concurrent chemoradiotherapy with S-1 for locally advanced squamous cell carcinoma of the head and neck in elderly cases and/or cases with comorbidity. Cancer Chemother Pharmacol 2009; 64: 945-952. – reference: 24) Argiris A, Stenson KM, Brockstein BE, et al: Neck dissection in the combined-modality therapy of patients with locoregionally advanced head and neck cancer. Head Neck 2004; 26: 447-455. – reference: 4) Budach V, Stuschke M, Budach W, et al: Hyperfractionated accelerated chemoradiation with concurrecnt fluorouracil-mitomycin is more effective than dose-escalated hyperfractionated accelerated radiation therapy alone in locally advanced head and neck cancer: final results of the radiotherapy cooperative clinical trials group of the German Cancer Society 95-06 Prospective Randomized Trial. J Clin Oncol 2005; 23: 1125-1135. – reference: 25) Lavertu P, Adelstein DJ, Saxton JP, et al: Management if the neck in a randomized trial comparing concurrent chemotherapy and radiotherapy with radiotherapy alone in resectable stage III and IV squamous cell head and neck cancer. Head Neck 1997; 19: 559-566. – reference: 3) Brizel DM, Albers ME, Fisher SR, et al: Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998; 338: 1798-1804. – reference: 12) Katori H, Tsukuda M, Taguchi T: Analysis of efficacy and toxicity of chemotherapy with cisplatin, 5-fluorouracil, methotrexate and leucovorin (PFML) and radiotherapy in the treatment of locally advanced squamous cell carcinoma of the head and neck. Cancer Chemother Pharmacol 2007; 59: 789-794. – reference: 28) Ong SC, Schöder H, Lee NY, et al: Clinical utility of 18F-FDG PET/CT in assessing the neck after concurrent chemoradiotherapy for locoregional advanced head and neck cancer. J Nucl Med 2008; 49: 532-540. – reference: 15) Tsukuda M, Ishitoya J, Matsuda H, et al: Randomized controlled phase II comparison study of concurrent chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil versus CCRT with cisplatin, 5-fluorouracil, methotrexate and leucovorin in patients with locally advanced squamous cell carcinoma of the head and neck. Cancer Chemother Pharmacol 2010; 66: 729-736. – reference: 17) Furukawa MK, Furukawa M: Diagnosis of lymph node metastases of head and neck cancer and evaluation of effect of chemoradiotherapy using ultrasonography. Int J Clin Oncol 2010; 15: 23-32. – reference: 22) Parsons JT, Mendenhall WM, Stringer SP, et al: Squamous cell carcinoma of the oropharynx; surgery, radiation therapy, or both. Cancer 2002; 94: 2967-2980. – reference: 20) Adelstein DJ, Li Y, Adams GL, et al: An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 2003; 21: 92-98. – reference: 5) Jermic B, Shibamoto Y, Milicic B, et al: Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. J Clin Oncol 2000; 18: 1458-1464. – reference: 21) Schöder H, Fury M, Lee N, et al: PET monitoring of therapy response in head and neck squamous cell carcinoma. J Nucl Med 2009; 50: 74S-88S. – reference: 1) Forastiere AA, Maor M, Weber RS, et al: Long-term results of Intergroup RTOG 91-11: a phase III trial to preserve the larynx-induction cisplatin/5-FU and radiation therapy versus concurrent cisplatin and radiation therapy versus radiation therapy [abstract]. J Clin Oncol 2006; 24: 18s. Abstract 5517. – reference: 6) Bonner JA, Harari PM, Giralt J, et al: Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006; 354: 567-578. – reference: 7) Calais G, Alfonsi M, Bardet E, et al: Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst 1999; 91: 2081-2086. – reference: 8) Taguchi T, Ikeda Y, Mikami Y, et al: Combined radiotherapy and chemotherapy with carboplatin and UFT for head and neck squamous cell carcinoma. Anticancer Res 2003; 23: 713-717. – reference: 10) Fujii M, Tsukuda M, Satake B, et al: Phase I/II trial of weekly docetaxel and concomitant radiotherapy for squamous cell carcinoma of the head and neck. Int J Clin Oncol 2004; 9: 107-112. – reference: 13) Katori H, Tsukuda M, Taguchi T: Concurrent chemoradiotherapy with carboplatin and uracil-tegafur (UFT) for patients with poor performance status with locally advanced squamous cell carcinoma of the head and neck (SCCHN). Acta Otolaryngol 2007; 127: 1099-1104. – reference: 2) Domange C, Hill C, Lefebvre JL, et al: Randomized trial of neoadjuvant chemotherapy in oropharyngeal carcinoma. French Groupe d'Etude des Tumeurs de la Tere et du Cou (GETTEC). 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Snippet | 背景: 化学療法併用放射線治療 (CCRT) が頭頸部扁平上皮癌 (HNSCC) 進行例に対し施行される機会が増えている. 頸部リンパ節の制御は予後に関与するため CCRT 後の治療効果... 「背景」 : 化学療法併用放射線治療 (CCRT) が頭頸部扁平上皮癌 (HNSCC) 進行例に対し施行される機会が増えている. 頸部リンパ節の制御は予後に関与するためCCRT後の治療効... |
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SubjectTerms | 化学療法併用放射線治療 感度と特異度 検査精度 頭頸部扁平上皮癌 頸部リンパ節転移 |
Title | 頭頸部扁平上皮癌に対する化学療法併用放射線治療後の頸部転移リンパ節の評価 |
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