RADIOTHERAPY ALONE OR COMBINED WITH NECK DISSECTION FOR T(1)T(2) CARCINOMA OF THE PYRIFORM SINUS - AN ALTERNATIVE TO CONSERVATION SURGERY
RADIOTHERAPY ALONE OR COMBINED WITH NECK DISSECTION FOR T(1)T(2) CARCINOMA OF THE PYRIFORM SINUS - AN ALTERNATIVE TO CONSERVATION SURGERY
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DOI：
10.1016/0360-3016(93)90518-z
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发表时间：
1993-12-01
影响因子：
7
通讯作者：
MILLION, RR
中科院分区：
文献类型：
--
作者：
MENDENHALL, WM;PARSONS, JT;MILLION, RR
目的：报告单纯放疗或联合颈淋巴清扫术治疗AJCC T1-T2梨状窝癌的经验，并与保守手术治疗结果进行比较。方法与材料：自1964年至1990年，收治73例AJCC T1-T2梨状窝癌。结果：T期患者的5年局控率和最终局控率分别为88%和94%，T2期患者的5年局控率和最终局控率分别为79%和91%。T2病变的患者在每天两次放疗后的局部控制率明显高于每天一次放疗(p=0.04)。然而，对各种参数的多变量分析显示，测试的变量中没有一项对这一终点有显著影响：声带活动度(p=.15)、每天一次与两次的分割(p=.33)、T1与T2(p=.32)、心尖侵犯(p=.58)以及治疗前CT扫描(p=.67)。保留喉音的T1癌和T2癌的局控率分别为88%和80%。根据AJCC分期，5年时锁骨上方的最终控制率为：I和II，100%；III，78%；IVA，75%；IVB，60%。5年特定原因生存的概率如下：I和II，100%；III，83%；IVA和IVB，51%。总体而言，9例(12%)患者出现严重并发症，其中一例死亡。结论：与采用保守手术的系列数据相比，单纯放疗或颈部清扫术的局部控制率和存活率相似，而致命并发症的风险显著降低。
Purpose: We present our experience with irradiation alone or combined with neck dissection for AJCC T1-T2 pyriform sinus carcinoma and compare our results to those obtained with conservation surgery.Methods and Materials: Seventy-three patients were treated between 1964 and 1990. All patients had a minimum of 2 years of follow-up; no patient was lost to follow-up.Results: The 5-year rates of local control and ultimate local control were, for Stage T, (17 patients), 88% and 94%; and for Stage T2 (56 patients), 79% and 91%. Patients with T2 lesions had a significantly higher rate of local control after twice-daily, compared with once-daily, irradiation (p = .04). However, a multivariate analysis of various parameters revealed that none of the variables tested significantly influenced this end point: vocal cord mobility (p = .15), once- vs. twice-daily fractionation (p = .33), T1 vs. T2 (p = .32), apex invasion (p = .58), and pretreatment CT scan (p = .67). Local control with laryngeal voice preservation was obtained in 88% of patients with T1 cancers and 80% of those with T2 cancers. Ultimate control above the clavicles at 5 years according to AJCC stage was as follows: I and II, 100%; III, 78%; IVA, 75%; and IVB, 60%. The probability of cause-specific survival at 5 years was as follows: I and II, 100%; III, 83%; and IVA and IVB, 51%. Overall, nine patients (12%) developed severe complications, one of which was fatal.Conclusion: Compared with available data from series using conservation surgery, radiotherapy alone or followed by neck dissection results in similar rates of local control and survival with a significantly lower risk of fatal complications.