Sakata K, Oouchi A, Nagakura H, Akiba H, Tamakawa M, Koito K, Hareyama M, Asakura K, Satoh M, Ohtani S
Department of Radiology, Sapporo Medical University, School of Medicine, Sapporo, Japan.
Int J Radiat Oncol Biol Phys. 2000 Apr 1;47(1):81-8. doi: 10.1016/s0360-3016(00)00409-0.
Hyperfractionated and accelerated radiotherapy without a split was performed to improve the local control probability of early glottic carcinomas. We analyzed the results of this regimen by using the Ki-67 index.
Over a 12-year period, 85 T1N0M0 glottic cancers and 50 T2N0M0 glottic cancers were treated with conventional fractionation (CF) from 1984 to 1989 and with accelerated fractionation (AF) since 1990. The CF program consisted of five daily fractions of 2 Gy per week, for a total of 64 Gy. The AF program consisted of 1.72 Gy per fraction, two fractions per day, 5 days a week, for a total of 55 or 58 Gy. The specimens, taken before radiotherapy, were immunohistochemically stained with anti-Ki-67 antibody.
The 5-year local control probability for T1 tumors was 79.6 +/- 6.9% with CF treatment, whereas with AF it was 86.9 +/- 5.6%. For T2 tumors it was 62.7 +/- 12.2% with CF, whereas it was 74.7 +/- 7.8% with AF. The difference between CF and AF did not reach the point of statistical significance. However, when T1 tumors had a Ki-67 index lower than 50%, the local control rate achieved with AF was significantly better than that with CF (p = 0.018). When the tumors had a Ki-67 index that was 50% or more, there was no difference in the local control rate between CF and AF, whether they were T1 or T2. The peak mucosal reactions at the larynx and/or hypopharynx were much more severe and appeared at smaller doses and earlier in AF than in CF. The patients with AF showed no severe late complications.
AF could not obtain statistically significant improvement in local control probability of T1 or T2 glottic carcinomas.
实施不分次的超分割加速放疗以提高早期声门癌的局部控制率。我们通过Ki-67指数分析了该治疗方案的结果。
在12年期间，1984年至1989年对85例T1N0M0声门癌和50例T2N0M0声门癌采用常规分割（CF）治疗，自1990年起采用加速分割（AF）治疗。CF方案为每周5次，每次2 Gy，总量64 Gy。AF方案为每次1.72 Gy，每天2次，每周5天，总量55或58 Gy。放疗前采集的标本用抗Ki-67抗体进行免疫组化染色。
CF治疗T1肿瘤的5年局部控制率为79.6±6.9%，而AF为86.9±5.6%。CF治疗T2肿瘤的5年局部控制率为62.7±12.2%，而AF为74.7±7.8%。CF和AF之间的差异未达到统计学意义。然而，当T1肿瘤的Ki-67指数低于50%时，AF的局部控制率显著优于CF（p = 0.018）。当肿瘤的Ki-67指数为50%或更高时，CF和AF在局部控制率上无差异，无论肿瘤是T1还是T2。喉部和/或下咽的黏膜反应高峰在AF组比CF组更严重，且在较小剂量时出现得更早。AF组患者未出现严重的晚期并发症。
AF在T1或T2声门癌的局部控制率方面未能取得统计学上显著的改善。
