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

本文对92例口腔鳞状细胞癌患者进行了高分割放疗（HF）加或不加化疗（CT），以改善治疗效果。所有患者的最终局部控制率为44.8%。这一较好的结果被认为与其中T2肿瘤的数量有关。与常规分割的标准放疗相比，单纯分割1.2Gy的HF对局部控制率没有任何改善。与单纯治疗HF相比，新辅助CT似乎能略微提高局部控制率。HF合并CT治疗的患者有较高的局部控制率。单独使用1.4Gy的HF可获得相似的局部控制率，新辅助CT联合使用1.4Gy的HF可获得更高的局部控制率。这些结果表明，更大的分数可能提供更高的局部控制率，更大的分数和CT联合HF也可能提供更好的局部控制率，即使CT是新伴或合并。CT联合HF治疗可明显提高局部控制率。结果表明：1)总剂量在80Gy及以上，仅心衰患者可耐受1.2或1.4Gy，心衰联合CT可耐受70-74Gy。2)无论有无CT，较小的肿瘤都是心衰的良好候选者，但对于较大的肿瘤，心衰的目标应该是降低分期，以便进行治疗性手术。3)最严重的晚期并发症是下颌骨坏死。虽然将下颌骨尽可能地排除在辐射场之外可能是最重要的，但在口腔癌的治疗中，将下颌骨排除在外是不可避免的。不仅在心衰之前，而且在心衰期间和之后，都需要进行深入的牙齿护理。这一并发症的改善应该是进一步应用HF合并或不合并CT治疗口腔癌的一个突破。少

Ninety two patients with previously untreated and biopsy-proven squamous cell carcinoma of the oral cavity were treated by hyperfractionated radiotherapy (HF) with or without chemotherapy (CT) to improve treatment results. Ultimate local control rates of all patients were 44.8%. This fairly good result was considered to be contributed by the number of T2 tumors among them. There was not any improvement in local control rates by HF alone with a fraction size of 1.2Gy compared with standard radiotherapy by conventional fractionation. Neoajuvant CT seemed to improve local control rates slightly than HF alone treatment. A higher local control rate was obtained in the patients treated by HF concomitantly with CT. Similar local control rate was obtained by HF alone with a fraction size of 1.4Gy, and the use of neoadjuvant CT combined to HF with a fraction size of 1.4Gy showed a higher local control rate. These results suggested that a larger fraction size might provide a higher local control … More rate and that CT combined with HF might also provide a better local control rate, even if CT was combined neoajuvantly or concomitantly. CT concomitantly combined with HF, however, provided a higher local control rate obviously. The results suggested followings ; 1)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 CT. 2)Smaller tumors were good candidates for HF with or without CT, but in larger tumors the goal of HF should be down-staging for a curative operation. 3)The severest late complication was the mandibular bone necrosis. Although it might be most important to exclude the mandible from an irradiated field as much as possible, it is inevitable to exclude the mandible in the treatment of oral cancer. Intensive dental care should be necessary not only before HF but also during and after it. The improvement of this complication should be a breakthrough for further application of HF with and without CT to oral cancers. Less