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

为提高放射治疗效果，对82例未经治疗并经活检证实的口腔鳞癌患者采用超分割放射治疗(HF)加化疗。T1~4的两年生存率分别为80.4%、65.5%、32.7%和5.8%。没有任何发现表明单独使用惠普可以提高存活率。然而，联合化疗似乎比单独使用HF更能提高局部控制率。肿瘤分期低的患者局部控制率较高，从器官保护的角度考虑，口腔癌体积较小应作为高频联合化疗的适应证。结果表明：(L)单纯高频分割为1.2Gy1.2或1.4Gy时可耐受80Gy以上的总剂量，高频联合化疗时总剂量为70~74Gy.2)无论化疗与否，较小的肿瘤都可以接受HF，但对于较大的肿瘤，HF的目标应该是降低分期以进行根治性手术。3)地方控制和区域控制共同影响患者的生存。4)单用心衰患者易发生急性反应，但联合用药往往需要间隔1-2周。5)最严重的远期并发症为下颌骨坏死。约在治疗后1.5至2年内发现。最重要的可能是尽可能地将下颌骨排除在照射野之外。这将通过提供仔细治疗计划的计算机模拟系统来完成。在放射治疗之前，建议紧急治疗牙科疾病，这可能是感染源之一。加强牙科护理不仅在放疗前是必要的，而且在放疗中和放疗后也是必要的。这一并发症的改善应该是进一步应用HF联合化疗和不联合化疗治疗口腔癌的一个突破。

Eighty two patients with previously untreated and biopsy-proven squamous cell carcinoma of the oral cavity were treated by hyperfractionated radiotherapy(HF) with chemotherapy to improve treatment results of radiotherapy. Two-year survival rates of T1 to 4 were 80.4%, 65.5%, 32.7%, and 5.8%, respectively. There was not any findings which improved survival rates by HP alone. However, combined chemotherapy seemed to improve local control rates than HF alone treatment. A higher local control rate was obtained in the patients with lower stages of tumors, and it was considered in the standpoint of organ preservation that a smaller size of buccal carcinoma should be an indication for HF combined with chemotherapy.The results showed followings ; l)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 chemotherapy. 2)Smaller tumors were good candidates for HF with or without chemotherapy, but in larger tumors the goal of HF should be down-staging for a curative operation. 3)Both local and regional controls influenced the survival. 4)Acute reactions in HF alone were torelable to patients, but those in the combined treatment often needed a split of 1-2 weeks. 5)The severest late complication was the mandibular bone necrosis. It was found about 1.5 to 2 years after the treatment. It might be most important to exclude the mandible from an irradiated field as much as possible. This would be accomplished with a computer-simulation system which provide careful treatment planning. Urgent treatment of dental diseases which might be a source of infection should be advisable before radiotherapy. Intensive dental care was necessary not only before radiotherapy but also during and after it. The improvement of this complication should be a breakthrough for further application of HF with and without chemotherapy to oral cancers.