Johansen L V, Grau C, Overgaard J
Department of Experimental Clinical Oncology Danish Cancer Society, Aarhus University Hospital, Denmark.
Acta Oncol. 2000;39(8):985-94. doi: 10.1080/02841860050215981.
In this retrospective study the results of primary and salvage treatment of oropharyngeal carcinoma were evaluated. A total of 289 consecutive patients (103 females and 186 males) were included in the study. Most tumours originated in the tonsil area (58%) and comprised stages I 8%, II 19%, III 46% and IV 28%. The primary treatment was delivered with curative intent in 276 cases (96%). Of these, 266 received primary radiotherapy. The median radiation dose was 62 Gy, given as laterally opposed fields to the primary tumour and bilateral neck. Eight patients were treated with primary surgery and two with chemotherapy as part of a curatively intended treatment programme including radiotherapy. Six patients received palliative treatment, and seven were not treated at all. Out of 276 tumours treated with curative intent, 173 reappeared; 72% recurred in T position, 38% in N position, and 12% at distant metastatic sites, some in combination. Salvage surgery was possible in 52 patients, and 24 treatments were successful. Salvage radiotherapy or cryotherapy was used in 22 patients and 4 were controlled. For the entire group, the 5-year locoregional tumour control, disease-specific survival and overall survival rates were 38%, 44% and 31%, respectively. For patients treated with curative intent, clinical T- and N-stage, stage, tumour size, gender, age, and pretreatment haemoglobin were significant prognostic parameters in a univariate analysis. The Cox multivariate analysis showed that T-stage, N-stage and gender were independent prognostic factors. It is concluded that T-stage, N-stage and gender are significant independent prognostic factors. The primary control of the carcinoma in the T-position is crucial for overall success, but salvage surgery is found to have a favourable success rate in patients suitable for relapse treatment.
在这项回顾性研究中，对口咽癌的初始治疗和挽救性治疗结果进行了评估。共有289例连续患者（103例女性和186例男性）纳入该研究。大多数肿瘤起源于扁桃体区域（58%），包括I期8%、II期19%、III期46%和IV期28%。276例（96%）患者的初始治疗旨在治愈。其中，266例接受了初始放疗。中位放疗剂量为62 Gy，采用对原发肿瘤和双侧颈部的对穿野照射。8例患者接受了初始手术，2例接受了化疗，作为包括放疗在内的治愈性治疗方案的一部分。6例患者接受了姑息治疗，7例未接受任何治疗。在276例接受治愈性治疗的肿瘤中，173例复发；72%在T部位复发，38%在N部位复发，12%在远处转移部位复发，部分为合并复发。52例患者可行挽救性手术，24例治疗成功。22例患者采用了挽救性放疗或冷冻治疗，4例得到控制。对于整个组，5年局部区域肿瘤控制率、疾病特异性生存率和总生存率分别为38%、44%和31%。在单因素分析中，对于接受治愈性治疗的患者，临床T和N分期、分期、肿瘤大小、性别、年龄和治疗前血红蛋白是重要的预后参数。Cox多因素分析显示，T分期、N分期和性别是独立的预后因素。得出结论，T分期、N分期和性别是重要的独立预后因素。原发癌在T部位的控制对于总体成功至关重要，但发现挽救性手术在适合复发治疗的患者中具有良好的成功率。
