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

为了提高口腔癌放疗的治疗效果，进行了超分割放疗联合化疗的临床试验。73例未经治疗和活检证实的口腔鳞状细胞癌患者被纳入研究。T1和T2的2年生存率高，为82.0%，这是由于sa1vage手术的贡献。没有发现单独使用高分割放疗能提高生存率。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，较小尺寸的口腔癌或颊癌应作为高分割放疗联合化疗的指征。相反，晚期疾病的局部控制率与以前公布的数据相同。在这些肿瘤的治疗中，术前应采用放疗。放疗使肿瘤体积缩小，使根治性手术成为可能，并可提供较高的局部控制率。急性黏膜反应的程度较单纯高分割放疗组严重，需要1 ~ 2周的间隔治疗。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戈瑞或更多的患者中，观察到牙周间隙变宽。这些并发症可能对治疗后患者的生活质量产生不利影响。口腔健康的密切管理是口腔疾病患者的必要条件，也是我们今后研究的课题。总剂量的改变以及化疗组合和剂量的改变将是一个应尽快披露的主题。

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.