POSTOPERATIVE RADIOTHERAPY IN HEAD AND NECK-CARCINOMA WITH EXTRACAPSULAR LYMPH-NODE EXTENSION AND OR POSITIVE RESECTION MARGINS - A COMPARATIVE-STUDY
POSTOPERATIVE RADIOTHERAPY IN HEAD AND NECK-CARCINOMA WITH EXTRACAPSULAR LYMPH-NODE EXTENSION AND OR POSITIVE RESECTION MARGINS - A COMPARATIVE-STUDY
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DOI：
10.1016/0360-3016(92)90646-y
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发表时间：
1992-01-01
影响因子：
7
通讯作者：
GRIMES, M
中科院分区：
文献类型：
--
作者：
HUANG, DT;JOHNSON, CR;GRIMES, M
在头颈癌中，发现包膜外淋巴结扩展和/或切除切缘阳性预示着局部区域控制和生存不佳。由于对切除患者与接受放射治疗的患者进行比较的研究不足，术后放疗对这些患者的有效性一直存在争议。 1982 年至 1988 年间，弗吉尼亚医学院进行了 441 例根治性头颈切除术。对这些病例进行病理学检查，发现 125 例有被膜外淋巴结扩展和/或切除边缘阳性。其中，43 例仅出现包膜外淋巴结扩展，24 例具有阳性切除边缘和包膜外淋巴结扩展，58 例仅显示阳性切除边缘。其中 71 例患者仅进行了手术，54 例患者接受了手术和术后放疗（联合治疗）CMT。放射治疗剂量范围为 50 至 70 Gy。单纯手术治疗组和联合治疗组在阳性切除边缘的分布和包膜外淋巴结扩展方面具有可比性。与单纯手术组相比，患有临床 T4 疾病的 CMT 患者略多（22% vs 14%）。与单独手术组相比，联合治疗组出现临床 NO 颈部症状的患者略少（20% vs 29%）。对变量 T、N 分期、放疗、切缘状态、原发肿瘤部位、显微镜下和肉眼可见的被膜外淋巴结延伸、阳性淋巴结数量、有被膜外淋巴结延伸的淋巴结数量进行多变量分析。联合治疗组中 59% 的局部区域控制维持了 5 年，而单独手术组中这一比例为 31% (p.0001)。亚组分析同样显示，对于仅阳性切缘（49% vs 41%；p = .04）、仅囊外淋巴结扩展（66% vs 31%；p = .03）和囊外淋巴结扩展 + 阳性切除边缘（68% vs 0%；p = .001），联合治疗组存在显着差异。调整后的生存率还显示，对于整个组来说，联合治疗与单独手术相比具有显着益处（72% vs 41%；p = .001）。多变量分析显示，放射治疗的使用对于局部控制和调整生存来说是一个非常有利的变量。肉眼可见的被膜外淋巴结穿透和阳性切除边缘是局部控制不利的自变量。 T 期是联合模式组中预测局部控制的唯一变量。在两个治疗组中，囊外延伸仍然是生存的重要负面预后变量。总之，本研究证明了对于具有包膜外淋巴结扩展和切除边缘阳性的高风险病理结果的患者，术后放疗具有局部控制和生存获益。
In head and neck carcinoma, the finding of extracapsular lymph node extension and/or positive resection margins portends poor locoregional control and survival. The effectiveness of postoperative radiotherapy in these patients has been controversial due to insufficient studies comparing resected patients with those also receiving radiation. Between 1982 and 1988, 441 radical head and neck resections were performed at the Medical College of Virginia. Pathologic review of these cases identified 125 with extracapsular lymph node extension and/or positive resection margins. Of these, 43 had extracapsular lymph node extension only, 24 had both positive resection margins and extracapsular lymph node extension, and 58 demonstrated positive resection margins only. Surgery alone was performed in 71 of these patients while 54 cases received surgery and postoperative radiotherapy, (combined modality treatment) CMT. Radiotherapy doses ranged from 50 to 70 Gy. The surgery alone and combined modality treatment groups were comparable with respect to the distribution of positive resection margins and extracapsular lymph node extension. Slightly more CMT patients had clinical T4 disease compared with the surgery alone group (22% vs 14%). Slightly fewer combined modality treatment patients had clinical NO necks than the surgery alone group (20% vs 29%). Multivariate analysis was performed with the variables T, N stages, radiotherapy, margin status, primary tumor sites, microscopic and macroscopic extracapsular lymph node extension, number of positive lymph nodes, number of nodes with extracapsular lymph node extension. Locoregional control was maintained at 5 years in 59% of the combined modality treatment group and 31% of the surgery alone group (p.0001). Subgroup analysis likewise reveals significant differences favoring the combined modality treatment group for positive resection margins only(49% vs 41%; p =.04),extracapsular lymph node extension only (66% vs 31%; p .03) and extracapsular lymph node extension + positive resection margins (68% vs 0%; p = .001). Adjusted survival also shows a significant benefit of combined modality treatment vs surgery alone for the entire group (72% vs 41%; p = .001). Multivariate analysis revealed that the use of radiotherapy is a strongly favorable variable for local control and adjusted survival. Macroscopic extracapsular lymph node penetration and positive resection margins are unfavorable independent variables for local control. T-stage is the only variable predicting local control in the combined modality group. Extracapsular extension remains an important negative prognostic variable for survival in both treatment groups. In conclusion, this study demonstrates a locoregional control and survival benefit for postoperative radiotherapy in patients with the high risk pathologic findings of extracapsular lymph node extension and positive resection margins.