An analysis of factors influencing the outcome of postoperative irradiation for squamous cell carcinoma of the oral cavity
An analysis of factors influencing the outcome of postoperative irradiation for squamous cell carcinoma of the oral cavity
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DOI：
10.1016/s0360-3016(97)00152-1
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发表时间：
1997-08-01
影响因子：
7
通讯作者：
Million, RR
中科院分区：
文献类型：
--
作者：
Parsons, JT;Mendenhall, WM;Million, RR
目的：分析影响晚期口腔鳞状细胞癌术后放疗疗效的因素。在1964年10月至1993年11月期间，134例患者，135例既往未经治疗的口腔原发性浸润性鳞状细胞癌在佛罗里达大学，术后连续进行外照射治疗。所有患者至少随访2年（分析，1995年12月）。结果：原发部位、颈部和局部区域控制的10年精算率分别为79%、88%和71%。35例患者出现锁骨上癌复发。94%的复发位于原发照射野（脊髓平面前方）;原发部位有24例复发，仅上颈部有9例复发。在脊髓平面后面的颈部区域没有失败（即，“后带”）。两例失效发生在甲状腺切迹水平以下的低颈部。在单变量分析中，影响局部区域控制的因素包括病理分期（I-II vs. III-IV，p = 0.04）、切缘状态（切缘浸润性癌vs.其他，p = 0.0007）、多灶性肿瘤（p = 0.05）、神经周围浸润（p = 0.04）和术后放疗适应症数量（p = 0.05）。囊外淋巴结延伸轻微显著（p = 0.07）。在多变量分析中，阳性边缘和适应症的数量仍然是显着的。这些因素被用来定义相对有利（< 4个适应症，边缘不阳性）和不利（大于或等于4个适应症和/或浸润性癌边缘阳性）的组。对于有利和不利的组，在45-50天内开始照射的患者与那些在以后开始照射的患者相比，局部区域控制的改善趋势不显著。对于接受较短总体放疗疗程治疗的患者，控制改善的趋势也不显著。还对整体“治疗包”持续时间的影响进行了分析（从手术日期到最后一天的照射）。对于不良肿瘤患者，总体“治疗包”小于或等于100天的患者局部区域控制的概率显著更高远处转移作为唯一失败部位的5年发生率为8%，其发生率与病理N分期有关（NO-NI，3%; N2-N3，16%，p = 0.02），以及囊外淋巴结延伸的存在（20%）或不存在（6%）（p = 0.06）。5年无复发率为63%。5年生存率和病因特异性生存率分别为50%和67%。四个严重的辐射损伤发生（3%）。结论：本文提供的数据，定义相对有利和不利的患者组在术后设置。有四种或四种以上放疗和/或手术切缘浸润性癌指征的患者比没有这些不利因素的患者结局更差;尽管不利组接受了更高剂量的放疗，但情况确实如此。不仅要注意手术和照射之间的间隔，而且要注意时间-剂量参数和治疗包的总持续时间。“（C）1997 Elsevier Science Inc.
Purpose: To analyze factors influencing outcome in patients who received postoperative irradiation for advanced squamous cell carcinoma of the oral cavity.Methods and Materials: Between October 1964 and November 1993, 134 patients with 135 previously untreated primary invasive squamous cell carcinomas of the oral cavity (excluding the lip) were treated postoperatively with continuous courses of external-beam irradiation at the University of Florida. All patients had a minimum follow-up of 2 years (analysis, December 1995). No patient was lost to follow-up.Results: The 10-year actuarial rates of primary site, neck, and local-regional control were 79%, 88%, and 71%, respectively. Recurrence of cancer above the clavicles developed in 35 patients. Ninety-four percent of the recurrences were within the primary field of irradiation (anterior to the plane of the spinal cord); there were 24 recurrences at the primary site and nine in the upper neck alone. There were no failures in the neck area behind the plane of the spinal cord (i.e., the ''posterior strip''). Two failures occurred in the low neck below the level of the thyroid notch. In univariate analyses, factors that affected local-regional control included pathologic stage (I-II vs. III-IV, p = 0.04), margin status (invasive cancer at the margin vs. other,p = 0.0007),multifocal tumor(p = 0.05), perineural invasion (p = 0.04), and number of indications for postoperative irradiation (p = 0.05). Extracapsular nodal extension was marginally significant (p = 0.07). In multivariate analysis, positive margins and number of indications remained significant. These factors were used to define relatively favorable (< 4 indications, margins not positive) and unfavorable (greater than or equal to 4 indications and/or margins positive for invasive cancer) groups.For both favorable and unfavorable groups, there were nonsignificant trends toward improved local-regional control for patients who began irradiation within 45-50 days, compared with those whose irradiation began later. There were also nonsignificant trends toward improved control for patients treated with shorter overall irradiation treatment courses. An analysis was also performed on the effects of duration of the overall ''treatment package'' (from the date of surgery until the lest day of irradiation). For patients with unfavorable tumors, there was a significantly higher probability of local-regional control for patients whose overall ''treatment package'' was less than or equal to 100 days (60% vs. 14%,p = 0.04).The 5-year rate of distant metastasis as the sole site of failure was 8% and was predicted by pathologic N stage (NO-NI, 3%; N2-N3, 16%,p = 0.02), as well as the presence (20%) or absence (6%) of extracapsular nodal extension (p = 0.06). The 5-year freedom-from-relapse rate was 63%. The 5-year survival and cause-specific survival rates were 50% and 67%, respectively. Four severe radiation injuries occurred (3%).Conclusion: This paper provides data that define relatively favorable and unfavorable groups of patients in the postoperative setting. Patients with four or more indications for irradiation and/or invasive cancer at the surgical margins have a worse outcome than patients who do not have these negative factors; this is true in spite of the fact that the unfavorable group received higher doses of radiation. Attention should be focused on not only the interval between surgery and irradiation, but also time-dose parameters and the overall duration of the treatment ''package.'' (C) 1997 Elsevier Science Inc.