文献摘要

頭頸部鱗狀細胞癌發生單一遠隔器官轉移之治療
Treatment of Oligometastatic Disease in Squamous Cell Carcinoma of the Head and Neck

Volume 5, Issue 1

關鍵字 :
頭頸癌,鱗狀細胞癌,單一癌症遠隔轉移,放射線治療,化學治療, Head and neck cancer, squamous cell carcinoma, oligometastatic disease, radiotherapy, chemotherapy.

作者 :
Aurora G. Vincent, MD, FACS ; Weitao Wang, MD ; Tom Shokri, MD; Yadranko Ducic, MD, FACS

譯者 :
中國醫藥大學附設醫院耳鼻喉部 花俊宏醫師

摘要:


Objective: No surgical or radiotherapeutic treatment guidelines exist for oligometastatic head and neck squamous cell carcinoma (oHNSCC), and only recently have interventions with curative intent been studied. Herein, we sought to elucidate survival rates among patients with oHNSCC to determine if treatment with curative intent is warranted in this population.


Study Design: Retrospective chart review.


Methods: We retrospectively reviewed cases of oHNSCC treated between March 1998 and March 2018. Fisher’s exact test was used to compare patients treated with radiotherapy (RT) to those who underwent surgical excision and to compare outcomes of patients with oligometastases at the time of initial presentation to those that developed oligometastatic disease after primary treatment.


Results: Eighty one patients with metastases to the lungs, ribs, pelvis, vertebral column, liver, clavicle, and sternum were included. Overall, 32 patients (40%) were alive 5 years post-treatment. The site of metastasis, the modality of treatment, and the time of development of oligometastatic disease did not significantly affect 5-year survival.


Conclusion: Herein, we demonstrate that multi-modality treatment of oHNSCC is warranted for some patients with an estimated 40% 5-year survival. Aggressive treatment of the primary and regional sites is necessary in addition to treatment of the metastatic site and incurs a survival benefit compared to patients with metastatic HNSCC treated with systemic therapy alone. oHNSCC should be approached separately from polymetastatic disease. Patients should be counseled about the possibility for long-term survival, and aggressive initial treatment with the intention for cure should be considered in this population.

專家評論:


頭頸部鱗狀細胞癌發生單一遠隔器官轉移之治療


中國醫藥大學附設醫院耳鼻喉部 花俊宏醫師


 頭頸癌一旦發生遠隔器官轉移,傳統上以化學治療為主,然而其存活率極差,五年存活率僅10-15%,平均生活於命僅十數個月,後期,Cetuximab為主的標靶治療以及Pembrolizuma等免疫治療陸續加入此等病患族群治療行列,裨益頭頸癌遠隔轉移病患存活,然而,關於手術及放射線治療在此等族群之相關卻無可參考之指引,因此研究團隊搜集該院病例,針對此一議題進行研究。


相較於多器官轉移,單一遠隔器官轉移具有較為有效的治療方式,同時也有較佳之療效,因此,針對單一遠隔器官轉移的治療亟需一臨床指引與建議。


團隊蒐集1998-2018二十年當中於單一醫院治療之頭頸癌並發生單一器官遠隔轉移之病患共81例,統計其轉移器官位置、治療方式以及預後進行分析,癌症原發部位包括喉、舌根、下咽以及食道,其原發部位均依常規接受手術、放射線、化學治療(platinum derivative and 5FU )或Cetuximab標靶治療,其中僅及少數病患曾接受Keytruda或Opdivo免疫治療,發生單一遠隔器官轉移的81例當中,以肺部轉移(66例; 82%)最常見,骨骼轉移(13; 16%)居次,單一肝轉移最少(2; 2%)。

 

66例肺轉移者有52(79%)例於頭頸癌診斷之初即為診斷,另14(21%)例於頭頸癌初始治療完成後方被發現,早期診斷之52例當中,44(85%)例接受放射線治療,另8(15%)例接受手術切除,其中一例並接受術後放射治療,44例接受放療者,20(45%)例發生復發並導致死亡,另24(55%)例則未於肺部發生復發,此24例僅接受放療者,五年活率達79%,至於其它8例接受手術切除肺腫瘤者,5(62%)例發生肺部復發及死亡,另3例則未於肺部發生復發。於完成頭頸癌初始治療後發現肺部轉移者有14(21%)例,7例接受肺部手術治療,另7例則僅接受放射線治療,兩組病患中約一半之病例發生肺部復發及死亡。綜合分析,66例單一肺轉移者存活五年以上者有27(41%)例。


單一骨轉移者有13位,分別發生於rib、pelvis、vetebral column、clavicle、sternum,與肺轉移類似,骨轉移確診可發生於頭頸癌診斷之初或完成治療之後,部分骨轉移病例接受放療,另部分則接受手術切除(部分並接受術後放射線治療),單一骨轉移存活5年以上者有5例(38%)。


單一肝轉移者有2例,距發現於治療之後,1例以手術治療,另1例以放療治療,2例因肝或多器官轉移致死。

        

此研究指出,單一遠隔器官轉移若積極以放射線治療或手術治療介入,其五年存活率約為40%,相較於以往單以化學治療控制的10-15%優異許多,至於單一遠隔器官轉移發現之早晚、以放療或手術介入治療,其於存活率表現則無差異。據此結果,針對單一遠隔器官轉移之頭頸癌病患,我輩實應以將其根治為治療之方向。另外,此研究甚少病例接受以anti-PD-L1為主的免疫治療,近年來分子免疫治療及細胞免疫治療蓬勃發展,在此等利器相佐之下,相信針對遠隔器官轉移的治療成績與生活品質改善定能再創佳績,而對於單一器官遠隔轉移者,傳統手術切除及放射線治療應再被重新重視以提昇治療成績。



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