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

本文对82例未经治疗并经活检证实的口腔鳞状细胞癌患者进行了高分割放疗（HF）联合化疗，以改善放疗效果。T1 ~ 4年生存率分别为80.4%、65.5%、32.7%、5.8%。没有任何发现表明单靠HP就能提高生存率。然而，联合化疗似乎比单独治疗HF提高了局部控制率。肿瘤分期较低的患者局部控制率较高，从器官保存的角度考虑，较小尺寸的颊癌应作为HF联合化疗的指征。结果表明：l)总剂量为80Gy或以上的HF患者单独可耐受1.2或1.4Gy， HF联合化疗可耐受70-74Gy。2)无论化疗与否，小肿瘤都是治疗HF的好选择，但对于较大的肿瘤，治疗HF的目标应该是降低分期，以便进行根治性手术。3)局部和区域控制都影响生存。4)单纯HF患者的急性反应是不可靠的，但联合治疗的患者往往需要1-2周的间隔。5)最严重的晚期并发症是下颌骨坏死。它是在治疗后1.5到2年被发现的。将下颌骨尽可能地排除在辐射场之外可能是最重要的。这将通过提供详细治疗计划的计算机模拟系统来完成。在放射治疗前，应紧急治疗可能是感染源的牙病。放疗前、放疗中、放疗后均需加强口腔护理。这一并发症的改善应成为氟化氢联合或不联合化疗在口腔癌中进一步应用的一个突破。

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.