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，进行了超分割放疗联合化疗的临床试验。73例既往未经治疗且经活检证实的口腔鳞状细胞癌患者入组研究。T1、T2期2年生存率高，为82.0%，主要是由于保留手术的贡献。单纯超分割放射治疗没有提高生存率的任何发现。然而，联合化疗似乎比单独放疗提高了局部控制率。肿瘤分期越低，局部控制率越高。从器官保存的角度考虑，小体积的牙龈癌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先前公布的数据相同。在这些肿瘤的治疗中，放射治疗应在术前意义上使用。放射治疗缩小肿瘤体积将使根治性手术成为可能，并可提供更高的局部控制率。急性粘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。在大多数接受70戈伊或以上的患者中，观察到牙周间隙增宽。这些并发症可能会对治疗后患者的生活质量产生不利影响。对患者口腔健康的密切管理是必要的，这是我们研究的前沿课题，化疗总剂量的改变以及联合用药和剂量的调整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.