McCord M W, Mendenhall W M, Parsons J T, Flowers F P
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, USA.
Int J Radiat Oncol Biol Phys. 1999 Feb 1;43(3):591-5. doi: 10.1016/s0360-3016(98)00474-x.
To address outcomes in clinically asymptomatic patients in whom the unexpected finding of microscopic perineural invasion is noted at the time of surgery.
The 35 patients included in this study had skin cancers of the head and neck treated with curative intent between January 1965 and April 1995 at the University of Florida. All patients were without clinical or radiographic evidence of perineural invasion but, at the time of biopsy or surgical excision, had the incidental finding of microscopic perineural invasion. Definitive therapy consisted of radiotherapy alone after lesion biopsy (3 patients) or surgical excision preceded (2 patients) or followed (30 patients) by radiotherapy. All patients had follow-up for at least 1 year, 13 patients (37%) had follow-up for at least 5 years.
The 5-year local control rate was 78%. The 5-year local control rate for the few patients treated with radiotherapy alone was statistically similar to that for patients treated with surgery and radiotherapy (100% vs. 77%, p = 0.4). Multivariate analysis for factors affecting local control included sex, histology, age, treatment group, clinical T stage, initial histologic differentiation, and previously untreated vs. recurrent tumors, none of which was found to be significant.
Both surgery plus radiotherapy and radiotherapy alone provide a relatively high rate of local control for patients with incidentally discovered perineural invasion secondary to skin cancer.
探讨手术时意外发现微小神经周围侵犯的临床无症状患者的治疗结果。
本研究纳入的35例患者于1965年1月至1995年4月在佛罗里达大学接受了根治性头颈部皮肤癌治疗。所有患者均无神经周围侵犯的临床或影像学证据，但在活检或手术切除时意外发现微小神经周围侵犯。确切治疗包括病变活检后单纯放疗（3例患者）或手术切除前（2例患者）或后（30例患者）进行放疗。所有患者至少随访1年，13例患者（37%）至少随访5年。
5年局部控制率为78%。少数单纯接受放疗的患者的5年局部控制率与接受手术和放疗的患者在统计学上相似（100%对77%，p = 0.4）。影响局部控制的因素的多变量分析包括性别、组织学、年龄、治疗组、临床T分期、初始组织学分化以及既往未治疗与复发性肿瘤，均未发现有显著意义。
手术加放疗和单纯放疗对因皮肤癌偶然发现神经周围侵犯的患者均提供了相对较高的局部控制率。
