POSTOPERATIVE IRRADIATION FOR SQUAMOUS-CELL CARCINOMA OF THE HEAD AND NECK - AN ANALYSIS OF TREATMENT RESULTS AND COMPLICATIONS
POSTOPERATIVE IRRADIATION FOR SQUAMOUS-CELL CARCINOMA OF THE HEAD AND NECK - AN ANALYSIS OF TREATMENT RESULTS AND COMPLICATIONS
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DOI：
10.1016/0360-3016(89)90006-0
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发表时间：
1989-01-01
影响因子：
7
通讯作者：
CASSISI, NJ
中科院分区：
文献类型：
--
作者：
AMDUR, RJ;PARSONS, JT;CASSISI, NJ
1964年10月至1984年10月，134例晚期头颈癌患者接受根治性手术和术后放射治疗。所有患者均≥2年，84% ≥。5年随访。本研究中包括的所有患者在对先前未经治疗的口腔、口咽、下咽或喉鳞状细胞癌进行大的癌症手术后计划接受连续过程的放射治疗，并开始放射治疗。手术后3个月。96%的人患有AJCC病理III期或IV期癌症，并且在照射开始时都没有明显的疾病证据。大多数锁骨上复发发生在原发区（84%），而不是后带（8%）或低颈（8%）。基于多变量分析和表格比较，发现4个因素对预测锁骨以上疾病控制非常重要：（a）手术切缘（5年精算控制，切缘浸润性癌为53%，切缘阴性为81%，p = 0.009）。切缘紧密或切缘原位癌患者的控制率与切缘阴性患者相同。(b)原发部位（口腔，64%，其他部位，83%; p = 0.029）。(c)颈部分期（N 0 -1 vs N2-3）。(d)照射适应症的数量，例如，骨侵入、多个阳性淋巴结、神经周围侵入（1-3个适应症，85%，相对于≥ 1个适应症）。4，62%; p = .06）。锁骨以上的疾病控制率与AJCC病理分期相关性不好：III期，67%; III期，81%; IVA期（T1-3，N2-3A），68%; IVB期（T4和/或N3 B），80%。手术和放射治疗开始之间的间隔（范围1-10周）也不具有统计学意义，即使根据肿瘤剂量、手术切缘和放射治疗适应症数量进行分层。5年时，整个组的精确生存率为33%;对于边缘有浸润性癌的患者，生存率约为边缘无浸润性癌患者的一半（17%对37%）。基于多变量分析，发现2个因素显著增加因癌症死亡的概率：（a）颈部分期（N 0 -1 vs N2-3）;（B）肿瘤从原发部位扩展到颈部皮肤或软组织。总体而言，7%的患者在联合治疗中出现了严重并发症。详细分析了原发部位和照射剂量的并发症发生率。
One hundred thirty-four patients with advanced head and neck cancer were treated with radical surgery and post-operative radiation therapy between October 1964 and October 1984. All patients had .gtoreq. 2 years and 84% had .gtoreq. 5 years of follow-up. All patients included in the study were scheduled to receive continuous-course irradiation following a major cancer operation for previously untreated squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx and began rdiation treatment .ltoreq. 3 months after the surgical procedure. Ninety-six percent had AJCC pathologic Stage III or IV cancer, and all were without evidence of gross disease at the start of irradiation. The majority of recurrences above the clavicles occurred in the primary field (84%) as opposed to the posterior strip (8%) or low neck (8%). Based on multivarate analysis and tabular comparisons, 4 factors were found to be significantly important for predicting disease control above the clavicles: (a) Surgical margin (5-year actuarial control with invasive cancer at the margin, 53%, versus 81% with negative margins, p = .009). Patients with close margins or in situ cancer at the margins had the same rate of control as those with negative margins. (b) Primary site (oral cavity, 64%, versus other sites, 83%; p = .029). (c) Neck Stage (N0-1 versus N2-3). (d) Number of indications for irradiation.sbd.for example, bone invasion, multiple positive nodes, perineural invasion (1-3 indications, 85%, versus .gtoreq. 4, 62%; p = .06). The rate of disease control above the clavicles did not correlate well with AJCC pathologic stage: Stage III, 67%; Stage III, 81%; Stage IVA (T1-3, N2-3A), 68%; Stage IVB (T4 and/or N3B), 80%. The interval between surgery and the start of irradiation (range 1-10 weeks) also was not prognostically important, even with stratification by tumor dose, surgical margin, and number of indications for irradiation. At 5 years, the actuarial survival rate was 33% for the entire group; for patients with invasive cancer at the margin, the survival rate was approximately half that of those whoe margins were free of invsive cnacer (17% versus 37%). Based on multivariate analysis, 2 factors were found to significantly increase the probability of death due to cancer: (a) neck Stage (N0-1 versus N2-3); (b) extension of tumor from the primary site into the skin or soft tissues of the neck. Overall, 7% of patients experienced a severe complication of combined therapy. A detailed analysis of the complication rates by primary site and irradiation dose is presented.