RESEARCH FOR IMPROVEMENT OF LOCAL CONTROL AND LATE EFFECT IN THE TREATMENT OF ORAL CANCER BY HYPERFRACTIONATED RADIOTHERAPY COMBINED WITH CHEMOTHERAPY

超分割放疗联合化疗改善口腔癌局部控制和迟发效果的研究

• 批准号: 14571787
• 负责人: FUJITA Minoru
• 金额: $ 2.18万
• 依托单位: Hiroshima University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2002
• 资助国家: 日本
• 起止时间: 2002 至 2004
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-14571787/
• 关键词: RADIOTHERAPY; HYPERFRACTIONATION; ORAL CANCER; CHEMOTHERAPY

Ninety two patients with previously untreated and biopsy-proven squamous cell carcinoma of the oral cavity were treated by hyperfractionated radiotherapy (HF) with or without chemotherapy (CT) to improve treatment results. Ultimate local control rates of all patients were 44.8%. This fairly good result was considered to be contributed by the number of T2 tumors among them. There was not any improvement in local control rates by HF alone with a fraction size of 1.2Gy compared with standard radiotherapy by conventional fractionation. Neoajuvant CT seemed to improve local control rates slightly than HF alone treatment. A higher local control rate was obtained in the patients treated by HF concomitantly with CT. Similar local control rate was obtained by HF alone with a fraction size of 1.4Gy, and the use of neoadjuvant CT combined to HF with a fraction size of 1.4Gy showed a higher local control rate. These results suggested that a larger fraction size might provide a higher local control … More rate and that CT combined with HF might also provide a better local control rate, even if CT was combined neoajuvantly or concomitantly. CT concomitantly combined with HF, however, provided a higher local control rate obviously. The results suggested followings ; 1)The total dose of 80Gy or more was tolerable to patients in the HF alone using a fraction size of 1.2 or 1.4Gy, and 70-74Gy in the HF combined with CT. 2)Smaller tumors were good candidates for HF with or without CT, but in larger tumors the goal of HF should be down-staging for a curative operation. 3)The severest late complication was the mandibular bone necrosis. Although it might be most important to exclude the mandible from an irradiated field as much as possible, it is inevitable to exclude the mandible in the treatment of oral cancer. Intensive dental care should be necessary not only before HF but also during and after it. The improvement of this complication should be a breakthrough for further application of HF with and without CT to oral cancers. Less

92 名先前未经治疗且经活检证实的口腔鳞状细胞癌患者接受超分割放疗 (HF) 联合或不联合化疗 (CT) 治疗，以改善治疗效果。所有患者的最终局部控制率为44.8%。这个相当好的结果被认为是其中T2肿瘤数量的贡献。与传统分割的标准放疗相比，1.2Gy 分割大小的单独 HF 的局部控制率没有任何改善。新辅助 CT 似乎比单独的 HF 治疗略微提高了局部控制率。 HF联合CT治疗的患者获得了较高的局部控制率。单独使用 1.4Gy 的 HF 获得了相似的局部控制率，而新辅助 CT 联合 1.4Gy 的 HF 则显示出更高的局部控制率。这些结果表明，较大的分数大小可能会提供更高的局部控制率，并且即使 CT 与新辅助或同时联合使用，CT 与 HF 相结合也可能提供更好的局部控制率。然而，CT联合HF明显提供了更高的局部控制率。结果建议如下； 1）单独使用1.2或1.4Gy分次大小的HF患者可耐受80Gy或以上的总剂量，HF联合CT使用70-74Gy的总剂量。 2）较小的肿瘤是有或没有 CT 的 HF 的良好候选者，但在较大的肿瘤中，HF 的目标应该是降期以进行治愈性手术。 3）最严重的晚期并发症是下颌骨坏死。尽管尽可能地将下颌骨排除在照射场之外可能是最重要的，但在口腔癌的治疗中不可避免地要排除下颌骨。不仅在心力衰竭之前，而且在心力衰竭期间和之后都需要进行强化牙科护理。这一并发症的改善应该是HF联合或不联合CT进一步应用于口腔癌的突破口。较少的