Mancuso A A, Mukherji S K, Schmalfuss I, Mendenhall W, Parsons J, Pameijer F, Hermans R, Kubilis P
Department of Radiology, University of Florida College of Medicine, Gainesville 32610-0374, USA.
J Clin Oncol. 1999 Feb;17(2):631-7. doi: 10.1200/JCO.1999.17.2.631.
To determine the utility of pretreatment computed tomography (CT) for predicting primary site control in patients with supraglottic squamous cell carcinoma (SCC) treated with definitive radiotherapy (RT).
Pretreatment CT studies in 63 patients were reviewed. Minimum length of follow-up was 2 years. Local recurrence and treatment complications resulting in permanent loss of laryngeal function were documented. Tumor volume was calculated using a computer digitizer, and pre-epiglottic space (PES) spread was estimated. The data were analyzed using a combination of Fisher's exact test, logistic regression modeling, and multivariate analyses. Five-year local control rates were calculated using the product-limit method.
Local control rates were inversely and roughly linearly related to tumor volume, although there seemed to be a threshold volume at which primary site prognosis diminished. Local control was 89% in tumors less than 6 cm3 and 52% when volumes were > or =6 cm3 (P = .0012). The likelihood of maintaining laryngeal function also varied with tumor volume: 89% for tumors less than 6 cm3 and 40% for tumors > or =6 cm3 (P = .00004). Pre-epiglottic space involvement by tumor of > or =25% was associated with a reduced chance of saving the larynx (P = .0076). Multivariate analyses revealed that only tumor volume independently altered these end points.
Pretreatment CT measurements of tumor volume permits stratification of patients with supraglottic SCC treated with RT alone (which allows preservation of laryngeal function) into groups in which local control is more likely and less likely. Pre-epiglottic space spread is not a contraindication to using RT as the primary treatment for supraglottic SCC.
确定治疗前计算机断层扫描（CT）在预测接受根治性放疗（RT）的声门上型鳞状细胞癌（SCC）患者原发部位控制情况方面的效用。
回顾了63例患者的治疗前CT研究。最短随访时间为2年。记录局部复发情况以及导致喉功能永久性丧失的治疗并发症。使用计算机数字化仪计算肿瘤体积，并评估会厌前间隙（PES）受累情况。采用Fisher精确检验、逻辑回归建模和多变量分析相结合的方法对数据进行分析。使用乘积极限法计算5年局部控制率。
局部控制率与肿瘤体积呈反比且大致呈线性关系，尽管似乎存在一个肿瘤体积阈值，超过该阈值原发部位预后会变差。肿瘤体积小于6 cm³时局部控制率为89%，体积≥6 cm³时为52%（P = 0.0012）。维持喉功能的可能性也随肿瘤体积而变化：肿瘤体积小于6 cm³时为89%，≥6 cm³时为40%（P = 0.00004）。肿瘤累及会厌前间隙≥25%与保喉机会降低相关（P = 0.0076）。多变量分析显示，只有肿瘤体积独立改变这些终点指标。
治疗前CT测量肿瘤体积可将单独接受RT治疗（可保留喉功能）的声门上型SCC患者分层为局部控制可能性较高和较低的组。会厌前间隙受累并非将RT作为声门上型SCC主要治疗方法的禁忌证。
