Carcinoma of the tongue base treated by transoral laser microsurgery, part one: Untreated tumors, a prospective analysis of oncologic and functional outcomes
Carcinoma of the tongue base treated by transoral laser microsurgery, part one: Untreated tumors, a prospective analysis of oncologic and functional outcomes
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DOI：
10.1097/01.mlg.0000244159.64179.f0
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发表时间：
2006-12-01
期刊：
影响因子：
2.6
通讯作者：
Perry, William C.
中科院分区：
文献类型：
--
作者：
Grant, David G.;Salassa, John R.;Perry, William C.
目的：报告经口激光显微手术 (TLM) 治疗未经治疗的原发性舌根癌的肿瘤学和功能结果。研究设计：两个中心前瞻性病例系列分析。方法：59例经病理证实的鳞状细胞癌患者； 1997年至2005年间接受TLM治疗舌根细胞癌，病理T分期分布为：T1，16； T2，23； T3,12 和 T4,8。 36 名患者患有 IV 期疾病，12 名患者患有 III 期疾病，7 名患者患有 II 期疾病，4 名患者患有 I 期疾病。 49 名患者 (83%) 进行了颈清扫术。 28 名患者（47%）接受了辅助放疗。分析的终点包括局部控制、局部区域控制、疾病特异性生存率和总体生存率。使用临床吞咽功能结果量表（FOSS）和沟通量表（CS）分期系统评估治疗前后的器官功能。结果。所有患者的平均随访时间为 31 个月。 2 年和 5 年 Kaplan-Meier 估计为： 局部控制，均为 90%；局部区域控制，均为 88%；无复发生存率均为 84%，总生存率分别为 91% 和 69%。所有患者的中位住院时间为 4 天。单独 TLM 的平均住院时间为 2.5 天，而 TLM 联合颈清扫术的平均住院时间为 4 天。三名患者（5%）术后出现轻微出血。术前中位 FOSS 分期为 0（功能正常）。术后中位 FOSS 分期为 1 级（功能正常，伴有阵发性或日常吞咽困难症状。）治疗后沟通功能没有临床显着变化。结论。经口激光手术是一种安全有效的治疗方法，适用于选择早期和晚期未经治疗的舌根鳞状细胞癌。此外，与 TLM 相关的低发病率和死亡率以及缩短的住院时间使其成为一种有吸引力的治疗选择。
Objectives: To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the management of untreated primary carcinoma of the tongue base. Study Design: A two center prospective case series analysis. Methods: Fifty-nine patients with pathologically confirmed squamous; cell carcinoma of the tongue base were treated with TLM between 1997 and 2005. The pathological T stage distribution was: T1, 16; T2,23; T3,12 and T4,8. Thirty-six patients presented with stage IV disease, 12 with stage III, 7 with stage II and 4 with stage I disease. Neck dissections were performed in 49 patients (83%). Twenty-eight patients (47%) underwent adjuvant radiotherapy. End points analyzed were local control, loco regional control, disease specific survival, and overall survival. Organ function was assessed before and after treatment using a clinical Functional Outcome Swallowing Scale (FOSS) and Communication Scale (CS) staging system. Results. The mean follow up for all patients was 31 months. The 2 and 5-year Kaplan-Meier estimates were: local control, both 90%; loco-regional control, both 88%; recurrence free survival, both 84% and overall survival 91% and 69% respectively. For all patients the median stay in hospital was 4 days. The median length of hospital visit for TLM alone was 2.5 days and 4 days for TLM with neck dissection. Three patients (5%) suffered minor postoperative hemorrhage. The median pre-operative FOSS stage was 0 (normal function.) The median postoperative FOSS stage was stage 1 (Normal function with episodic or daily symptoms of dysphagia.) There were no clinically significant changes in communication function after treatment. Conclusions. Transoral laser surgery is a safe and effective treatment for select early and advanced previously untreated squamous cell cancer of the tongue base. In addition, the low morbidity and mortality and shortened duration of hospitalization associated with TLM make it an attractive therapeutic alternative.