Robertson M L, Gleich L L, Barrett W L, Gluckman J L
Department of Otolaryngology-Head and Neck Surgery, The University of Cincinnati Medical Center, 213 Bethesda Avenue, Cincinnati, OH 45267-0528, U.S.A.
Laryngoscope. 2001 Aug;111(8):1362-5. doi: 10.1097/00005537-200108000-00009.
Base-of-tongue cancer has traditionally been treated by surgical resection followed by radiation therapy. Primary radiation therapy with brachytherapy has recently been proposed as an alternative. In a prior analysis, we found that patients with advanced tongue-base cancer treated by total glossectomy and postoperative radiation therapy can be cured while potentially maintaining good quality of life. Therefore, we designed the current study to assess survival, function, and quality of life in our patients with tongue-base cancer who were treated with primary radiation therapy and brachytherapy with neck dissection as indicated.
Consecutive case series.
Twenty patients were treated between 1993 and 1997 using the approach just named. The T stages were T1 (3), T2 (10), T3 (6), and T4 (1). The N stages were N0 (3), N1 (3), N2 (11), and N3 (3). At the time of brachytherapy catheter placement, neck dissections were performed in all 14 patients with N2 or N3 disease. Surviving patients completed a functional status survey and quality of life questionnaire.
The 3- and 5-year Kaplan-Meier corrected actuarial survival rates were 57% and 38%, respectively. Eight patients remained alive at the time of this writing and completed the functional status survey and quality of life assessment. Function and quality of life were well maintained in patients treated with external-beam irradiation followed by brachytherapy and neck dissection. However, none of our patients with T3 disease had long-term survival.
Although we do not endorse external-beam irradiation and brachytherapy for advanced tongue-base cancers, this treatment should be strongly considered for patients with T1 or T2 tumors in whom preservation of function and quality of life is a priority.
舌根癌传统上采用手术切除加放射治疗。最近有人提出采用近距离放射治疗的原发性放射治疗作为替代方案。在之前的一项分析中，我们发现接受全舌切除术和术后放射治疗的晚期舌根癌患者可以治愈，同时有可能维持良好的生活质量。因此，我们设计了本研究，以评估接受原发性放射治疗和根据需要进行颈部清扫的近距离放射治疗的舌根癌患者的生存率、功能和生活质量。
连续病例系列。
1993年至1997年间，20例患者采用上述方法进行治疗。T分期为T1（3例）、T2（10例）、T3（6例）和T4（1例）。N分期为N0（3例）、N1（3例）、N2（11例）和N3（3例）。在放置近距离放射治疗导管时，所有14例N2或N3期疾病患者均进行了颈部清扫。存活患者完成了功能状态调查和生活质量问卷。
3年和5年的Kaplan-Meier校正精算生存率分别为57%和38%。在撰写本文时，8例患者仍存活，并完成了功能状态调查和生活质量评估。接受外照射后行近距离放射治疗和颈部清扫的患者功能和生活质量得到良好维持。然而，我们的T3期疾病患者均无长期生存。
虽然我们不支持对晚期舌根癌进行外照射和近距离放射治疗，但对于功能和生活质量的保留是首要考虑因素的T1或T2期肿瘤患者，应强烈考虑这种治疗方法。
