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

为提高口腔癌放射治疗效果，进行了超分割放射治疗配合化疗的临床试验。73名以前未经治疗并经活检证实的口腔鳞状细胞癌患者参加了这项研究。T1、T2的2年生存率较高，达82.0%，主要得益于手术的挽救。没有任何发现可以通过单纯超分割放射治疗来提高生存率。然而，联合化疗似乎比单纯放疗更能提高局部控制率。肿瘤分期越低，局部控制率越高，从器官保护的角度考虑，肿瘤体积较小的肿瘤或颊癌应作为超分割放疗联合化疗的适应证。相反，晚期疾病的局部控制率与之前公布的数据相同。在这些肿瘤的治疗中，放射治疗应在术前的意义上进行。通过放射治疗缩小肿瘤体积将使根治性手术成为可能，并可提供较高的局部控制率。急性黏膜反应程度较单纯超分割放疗严重，需间隔1~2周。晚期并发症的发生率可能更高。分别是放射性骨髓炎和放射性骨坏死。大部分受照70Gy以上的患者牙周间隙增宽。这些并发症可能会对患者治疗后的生活质量产生不利影响。口腔健康的密切管理对患者是必要的，也是我们研究的前沿课题，改变化疗总剂量、调整化疗组合和剂量将是一个应尽快披露的课题。

To improve treatment results of radiotherapy for oral cancers, a clinical trial of hyperfractionated radiotherapy with chemotherapy was conducted. Seventy three patients with previously untreated and biopsy-proven squamous cell carcinoma of the oral cavity were entered in the study. The 2-year survival rate of T1 and T2 was high, 82.0%, because of contribution of sa1vage operation. There was not any findings which improved survival rates by hyperfractionated radiotherapy alone. However, combined chemotherapy seemed to improve local control rates than radiotherapy 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 gaingival or buccal carcinoma should be an indication for hyperfractionated radiotherapy combined with chemotherapy. On the contrary, a local control rate of advanced diseases was the same as that of previously published data. In the treatment of these tumors, radiotherapy should be used in preoperative sense. Volume reduction of tumors by radiotherapy will make a radical operation possible and it may provide a higher local control rate. The grade of acute mucosal reaction was severer than that in the hyperfractionated radiotherapy alone and a split of 1-2-weeks was needed. The incidence of late complications might be higher. Those were radiation osteomyelitis and osteoradionecrosis. In most patients who received 70 Gy or more, the widening of periodontal space was observed. These complications may affect adversely a QOL of patients after treatment. The close management for the oral health was necessary in the patients and it is the forecoming subject in our study.Alteration of total dose and modifications of both combination and dosage of chemotherapy would be a subject which should be disclosed as quickly as possible.