Goleń M, Składowski K, Maciejewski B
I Clinic of Radiotherapy, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Gliwice, Poland.
Neoplasma. 1999;46(1):66-71.
There are some clinical evidences, that the same types of tumors originated from neighboring anatomical structures can significantly differ in their response to radiation therapy. Squamous cell cancer of supraglottis and glottis could be good examples of this phenomenon. The purpose of the study was to compare the radiocurability of cancers localized in the upper and medium level of the larynx. From 1985 to the end of 1989, 544 patients with squamous cell cancer of the larynx were treated by radiotherapy alone. There were 388 patients with supraglottic cancer and 156 patients with glottic cancer. The total dose was in the range of 59-74 Gy. The end-point criteria were overall (OS) and disease-free survival (DFS). Generally, 5-year overall and disease-free survival rates were significantly more favorable for glottic cancer patients than for supraglottic cancer (67 and 63% vs. 40 and 36%, respectively). Significant differences in both disease-free and overall survival between supraglottic and glottic cancer in aspect of several analyzed clinical prognostic factors were found for: male sex, age, pattern of tumor growth, clinical performance status, radiation total dose lower than 70 Gy, fraction doses and overall treatment time. In all these prognostic categories 5-year survival rates were lower for supraglottic cancer patients. This tendency disappeared when the treatment results were compared in aspect of tumor stage (T). Tumor cure doses for 50% probability of local control (TCD50) in supraglottic cancer were estimated as: 61 Gy (T(1+2)) and 66 Gy (T3). In glottic cancer the lower TCD50 values of 54.5 Gy (T(1+2)) and 61 Gy (T3) were found in comparable treatment time. The comparative estimation of cure rates (i.e. OS and DFS) of laryngeal cancer treated by radiation alone showed that in aspect of almost all analyzed prognostic factors the greater risk of treatment failure was significantly associated with supraglottic origin.
有一些临床证据表明，源自相邻解剖结构的相同类型肿瘤对放射治疗的反应可能存在显著差异。声门上区和声门区的鳞状细胞癌就是这一现象的典型例子。本研究的目的是比较局限于喉上部和中部的癌症的放射可治愈性。1985年至1989年底，544例喉鳞状细胞癌患者仅接受放射治疗。其中声门上癌患者388例，声门癌患者156例。总剂量在59 - 74 Gy范围内。终点标准为总生存期（OS）和无病生存期（DFS）。总体而言，声门癌患者的5年总生存率和无病生存率明显优于声门上癌患者（分别为67%和63%，对比40%和36%）。在以下几个分析的临床预后因素方面，声门上癌和声门癌在无病生存期和总生存期上均存在显著差异：男性、年龄、肿瘤生长模式、临床性能状态、放射总剂量低于70 Gy、分次剂量和总治疗时间。在所有这些预后类别中，声门上癌患者的5年生存率较低。当从肿瘤分期（T）方面比较治疗结果时，这种趋势消失。声门上癌局部控制概率为50%时的肿瘤治愈剂量估计为：61 Gy（T(1 + 2)）和66 Gy（T3）。在声门癌中，在可比的治疗时间内发现较低的TCD50值，分别为54.5 Gy（T(1 + 2)）和61 Gy（T3）。对仅接受放射治疗的喉癌治愈率（即OS和DFS）的比较估计表明，在几乎所有分析的预后因素方面，治疗失败风险较高与声门上起源显著相关。
