摘要
目的 比较 132例T1、T2 期下咽癌患者手术 +放射治疗与单纯放射治疗的疗效。方法 132例T1、T2 期下咽癌患者中 ,5 1.5 %肿瘤直径在 2～ 4cm范围内 ,83.3%来源于梨状窝。颈部淋巴结阴性 (N0 )者占总数的 5 0 %。治疗分为 3个组 ,即部分咽喉切除术 +术后放射治疗 (PPL +RX)组 (4 4例 ) ,全咽喉切除术 +术后放射治疗 (TPL +RX)组 (4 0例 ) ,单纯放射治疗 (RX)组 (4 8例 )。术后放射治疗原发灶区和 (或 )颈淋巴引流区的放射剂量为 45～ 5 5Gy。单纯放射治疗的照射剂量原发灶区为 75Gy,颈淋巴引流区为 45～ 5 5Gy ,颈转移淋巴结处总量达 75Gy。生存率计算采用Kaplan Meier法 ,显著性检验采用Logrank法。结果 总 1、3、5年生存率分别为 71%、45 %、34%。单纯放射治疗组与术后放射治疗组间的 1、3、5年生存率比较 ,后者治疗效果均优于前者 (PPL +RX与RX :χ2 =7.0 1,P <0 .0 1;TPL +RX与RX :χ2 =4.0 1,P <0 .0 5 )。咽喉全切除术或部分切除 +术后放射治疗组间的 1、3、5年生存率差异无显著性意义 (χ2 =1.85 ,P >0 .10 )。N0 者行颈清扫 +术后放射治疗与单纯放射治疗的颈淋巴区的控制率差异也无显著性意义 (χ2 =1.96 ,P >0 .10 ) ,但术前颈淋巴结有临床转移者 (N+)则颈清扫具有明显优势 (χ2 =12 .2 1。
Objective To compare the treatment results of surgery with or without radiotherapy in T 1/T 2 hypopharyngeal carcinoma. Methods In 132 T 1 and T 2 lesions, the size of the tumor was between 2～4 cm in 51.5% of patients. The primary tumor was localized in the pyriform sinus in 83.3% of patients. Half of these patients had cervical lymph node metastasis at presentation. The patients were treated by total pharyngo laryngectomy and radiotherapy in 40 patients, partial pharyngo laryngectomy and radiotherapy in 44, and radiotherapy alone in 48. For post operative radiotherapy, 45 Gy to 55 Gy was delivered to the primary site and/or lymph nodes. For radiotherapy alone, patients received 75 Gy to the primary tumor, 45～55 Gy to the neck (lymph node negative), and 75 Gy to palpable cervical lymph nodes. Kaplan Meier method was used in the evaluation of survival rate, and logrank test for comparison between groups. Results The overall survival rates at 1, 3 and 5 years for all patients were 71%, 45% and 34%, respectively. Surgery followed by radiotherapy showed a better survival than radiotherapy alone (P<0.01). No significant difference in the survival rates was observed between total laryngectomy plus radiotherapy and partial pharyngectomy plus radiotherapy (P>0.10). It is interesting to note that, for patients who did not have cervical lymph node metastasis, addition of neck dissection to radiotherapy did not improve the local regional control rate as compared to radiotherapy alone (P>0.10). However, for patients with positive cervical lymph nodes, neck dissection plus radiotherapy resulted in a better local control rate than radiotherapy alone (P<0.001). Conclusions Patients with early stage hypopharyngeal carcinoma can be treated with a combination of surgery and radiotherapy as a primary treatment. We recommend prophylactic cervical irradiation alone for those patients with negative cervical lymph node.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2000年第4期229-231,共3页
Chinese Journal of Radiation Oncology
关键词
下咽癌
综合治疗
放射治疗
外科手术
Hypopharyngeal carcinoma/surgery
Hypopharyngeal carcinoma/radiotherapy
Combined modality therapy
Prognosis
