The treatment of early laryngeal cancers (T1-T2 N0): Surgery or irradiation?
The treatment of early laryngeal cancers (T1-T2 N0): Surgery or irradiation?
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DOI：
10.1002/hed.10361
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发表时间：
2004-02-01
影响因子：
2.9
通讯作者：
Husband, DJ
中科院分区：
文献类型：
--
作者：
Jones, AS;Fish, B;Husband, DJ
背景资料。喉癌是头颈部最常见的癌症。在北欧，早期喉癌几乎普遍通过放射治疗，但在其他地方，它是通过手术治疗的。这项研究的主要目的是确定两种主要治疗方案在存活率方面是否有任何差异。第二个目标是评估来自每个治疗组的小样本患者的语音和声音质量。研究对象为488例T1-2患者，无喉鳞状细胞癌。这些患者构成了我们机构三十多年来治疗这种疾病的未经选择的连续组。放射治疗419例，手术治疗69例。大多数手术患者在该系列的早期接受治疗，而放射治疗后来成为治疗的首选。主要的预后指标是原发灶复发、颈部复发和肿瘤特有的存活率。第二项结果是语音和声音质量。统计分析采用单因素和多因素的关联分析和生存分析。手术包括水平或垂直部分喉切除和各种声门小手术，包括声带切除术。在30年的时间里，放射治疗的剂量为60-66Gy30-33次/天。手术倾向于在早期进行，之后进行放射治疗。手术更有可能是为声门上型疾病进行的。除去这些差异，放疗组和手术组的患者很好地匹配。接受放射治疗的患者的5年肿瘤特异性存活率为87%，手术治疗的患者为77%(p=.1022)。声门癌和T1疾病与较高的5年生存率相关：分别为90%和91%。声门上型病变和T2病变的预后均较差，分别为79%和69%，两组数据差异显著。两种治疗方式的原发部位复发率没有显著差异，但手术组的区域复发率较高。进一步的分析表明，这不是手术本身的作用，而是该单位在进行手术时对无颈的政策。在语音和声音质量方面，放射治疗远远优于手术。放疗组的10例患者中仅有3例嗓音良好或正常(p=0.0017)。在治疗早期喉癌方面，手术和放疗同样有效。接受放射治疗的患者的语音和声音质量比接受手术治疗的患者要好得多。(C)2004年威利期刊公司。
Background. Carcinoma of the larynx is the most common cancer affecting the head and neck region. In Northern Europe, early laryngeal cancer is almost universally treated by irradiation, but elsewhere it is treated by surgery. The main aim of this study was to determine whether there was any difference in survival between the two main therapeutic options. The secondary aim was to assess speech and voice quality in a small, randomized sample of patients from each treatment group.Methods. The subjects investigated were 488 patients with T1-2, NO squamous cell carcinoma of the larynx. The patients form an unselected sequential group of our institution's experience with treating this disease over three decades. Four hundred nineteen patients were treated by irradiation, and 69 were treated with surgery. Most surgical patients were treated earlier in the series, whereas radiotherapy later became the treatment of choice. The primary outcome measures were recurrence at the primary site, recurrence in the neck, and tumor-specific survival. The secondary outcome measure was speech and voice quality. Statistical analysis was by univariate and multivariate analysis of association and survival. Surgery included horizontal or vertical partial laryngectomy and various minor procedures on the glottis, including cordectomy. Over a 30-year period, radiotherapy was administered to a dose of 60-66 Gy given over 30-33 daily fractions.Results. Surgery tended to be performed early on in the series and radiotherapy thereafter. Surgery was more likely to be carried out for supraglottic disease. These differences apart, the radiotherapy and surgery groups of patients were well matched. The 5-year tumor-specific survival for those treated by irradiation was 87% and for surgery it was 77% (p = .1022). Glottic cancer and T1 disease were associated with high 5-year survivals: 90% and 91%, respectively. Supraglottic site and T2 disease both had a poorer prognoses: 79% and 69%, respectively, The differences for both sets of data were significant. There was no significant difference in primary site recurrence rates for the two treatment modalities, but regional recurrence was higher in the surgery group. Further analysis demonstrated that this was not a function of surgery per se but rather of the unit's policy toward the NO neck at the time surgery was carried out. Regarding speech and voice quality, radiotherapy was far superior to surgery. All patients in the radiotherapy group but only 3 of 10 in the surgery group were judged to have a good or normal voice (p = .0017).Conclusions. Both surgery and irradiation are equally effective at treating early laryngeal carcinoma. Speech and voice quality were highly significantly better in patients treated by irradiation than in those treated by surgery. (C) 2004 Wiley Periodicals, Inc.