NEJM:PET-CT监测 vs 颈清扫术治疗晚期头颈部肿瘤

2016-03-24 崔倩 译 MedSci原创

图像引导的监督作用与计划颈清扫术治疗相比,对于头部和颈部的鳞状细胞癌患者(晚期淋巴结病阶段N2或N3,主要治疗为放化疗)的效果,仍然是一个有争议的问题。原始出处:Hisham Mehanna,Wai-Lup Wong,Christopher C. McConkey,et al.PET-CT Surveillance versus Neck Dissection in Advanced Head a

与计划颈清扫术治疗相比,图像引导的监督作用对于头部和颈部的鳞状细胞癌患者(晚期淋巴结病阶段N2或N3,主要治疗为放化疗)的效果,仍然是一个有争议的问题。

在这项前瞻性、随机、对照试验中,研究人员评估了通过PET-CT的非劣效性-引导监控(在放化疗结束的12周后进行,如果PET-CT显示不完整的或模棱两可的响应,则进行颈淋巴清扫术)计划N2或N3阶段疾病患者颈淋巴结清扫术。主要终点是总生存期。

从2007年到2012年,研究人员在英国37个中心招募了564例患者(计划手术组282例患者,监测组282例)。在这些患者中,17%有淋巴结N2a期疾病,61%有N2b阶段疾病。共有84%的患者有口咽癌,75%的患者肿瘤标本显示p16蛋白染色阳性,这表明人类乳头状瘤病毒在癌症有因果关系的作用。中位随访时间为36个月。PET-CT引导监视导致比计划的清扫手术有更少的颈清扫术(54与221);手术并发症率在两组(分别为42%和38%,)类似。2年总生存率监视组为84.9%(95%可信区间[CI],80.7到89.1),计划手术组为81.5%(95%CI,76.9到86.3)。PET-CT引导的监视死亡的危险比略高,表明了非劣效性(对于危险比,95%CI的上边界为<1.50;P=0.004)。p16的表达在两组间无显著差异。生活质量是在这两个组中相似。PET-CT引导下的监视,与颈淋巴清扫术相比,导致在整个试验期间每人节省了1492£(约$ 2,190美元)。

接受PET-CT引导监视和那些接受计划颈淋巴结清扫术的患者的生存效益是相似的,但监测可减少很多手术,这更具成本效益。

原始出处:

Hisham Mehanna,Wai-Lup Wong,Christopher C. McConkey,et al.PET-CT Surveillance versus Neck Dissection in Advanced Head and Neck Cancer,NEJM,2016.3.23
 

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    2016-05-02 feather89
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    2016-03-25 智慧医人
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    2016-03-25 saikp
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    2016-03-25 wshxjq
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