RESEARCH FOR IMPROVEMENT OF TUMOR CONTROL AND QOL IN THE TREATMENT OF ORAL CANCER BY HYPERFRACTIONATED RADIOTHERAPY WITH AND WITHOUT CHEMOTHERAPY

对92例未经治疗并经活检证实的口腔鳞癌患者进行超分割放疗(HF)加或不加化疗(CT)，以提高治疗效果和生活质量。其中56名患者被分析，因为他们在整个治疗过程中使用了统一的分数大小。1.2Gy超分割组最终局控率为39%，1.4Gy超分割组为56%。在接受新辅助CT治疗的患者中，1.2Gy超分割组局部控制率为23%，1.4Gy超分割组局部控制率为100.00%。在无患者中，1.2Gy组存活19/25例，1.4Gy组存活17/22例。在两组患者中，N+患者均未得到局部控制。在39例放疗后存活2年以上的患者中，21例有晚期放射损伤。这些症状是牙齿脱落、骨外露和骨坏死。21例中有9例发生晚期损伤，早期局部控制率约为50%，病因特异性存活率约为70~80%。这一发现表明，“手术第一”的意向应该是一种更好的选择治疗意识。在晚期病例中，局部控制者也不能达到区域控制，故应更多地讨论手术加放疗和CT加放疗的联合治疗。晚期辐射损伤的高发生率肯定是HF使用的一个大问题，特别是对于口腔癌患者。

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 and quality of life (QOL). Fifty six patients among them were analyzed because an uniform fraction size was used through out their treatment. Ultimate local control rates of 1.2Gy fraction group was 39%, and that of 1.4Gy fraction group was 56%. Among patients received neoadjuvant CT, local control rates of 1.2Gy fraction group was 23%, and that of 1.4Gy fraction group was 100%. Among NO patients, 19/25 patients were alive in 1.2Gy fraction group and 17/22 in 1.4Gy fraction group. In both fraction groups N+ patients were not controlled locally. Among 39 patients who were alive more than 2 years after radiotherapy, 21 had late radiation damages. Those were exfoliation of teeth, bone exposure, and bone necrosis. Nine patients in 21 had late damage after salvage operation.In early stage patients a local conrol rate was about 50% and a cause-specific suvival rate 70-80%. This finding indicated that "operation first" intent should be a better selection sense of treatment. On the other hand, combination of operation and radiotherapy and combination of CT and radiotherapy should be more discussed in advanced cases because regional control was not achieved even in locally-controlled patients. High incidence of late radiation damage must be a big problem on the usage of HF especially for patients with an oral cancer.