Mendenhall William M, Morris Christopher G, Amdur Robert J, Hinerman Russell W, Mancuso Anthony A
Department of Radiation Oncology, University of Florida Health Science Center, P. O. Box 100385, Gainesville, Florida 32610-0385, USA.
Head Neck. 2003 Jul;25(7):535-42. doi: 10.1002/hed.10253.
To analyze parameters that may influence the likelihood of local control after definitive radiotherapy for head and neck cancer.
Between April 1980 and January 2000, 404 patients were treated with definitive RT alone (358 patients) or combined with adjuvant chemotherapy (46 patients) at our institution and were followed up for 0.25 to 20.25 years (median, 3.5 years.) All living patients were followed up for at least 2 years. All patients had the primary tumor volume calculated on pretreatment CT. End points were local control after RT and local control after RT without a severe late complication. Parameters evaluated in multivariate analyses of these end points included primary site, T stage, primary tumor volume, N stage, histologic differentiation, fractionation schedule, adjuvant chemotherapy, and gender.
The rates of local control and local control without a severe late complication after RT were significantly influenced by primary tumor volume for patients with cancer of the supraglottic larynx and true vocal cord. In contrast, the rates of local control and local control without severe complications for patients with tumors of the oropharynx and hypopharynx were less influenced by tumor volume. Multivariate analysis of the overall population revealed that the only parameter that was significantly related to the probability of local control after RT was T stage. Multivariate analyses stratified by primary site revealed that tumor volume significantly influenced local control for patients with cancers of the supraglottis (p =.0220) and glottis (p =.0042) but not for those with lesions of the tonsillar fossa/posterior tonsillar pillar (p =.0892), base of tongue (p =.9493), anterior tonsillar pillar/soft palate (p =.5909), and hypopharynx (p =.2282).
The most important parameter that has an impact on local control after RT is T stage. Primary tumor volume also significantly influences the probability of local control in cancers of the supraglottis and glottis.
分析可能影响头颈部癌根治性放疗后局部控制可能性的参数。
1980年4月至2000年1月期间，404例患者在我院接受单纯根治性放疗（358例患者）或联合辅助化疗（46例患者），随访时间为0.25至20.25年（中位时间为3.5年）。所有存活患者至少随访2年。所有患者均在治疗前CT上计算原发肿瘤体积。终点指标为放疗后的局部控制情况以及放疗后无严重晚期并发症的局部控制情况。在对这些终点指标进行多因素分析时评估的参数包括原发部位、T分期、原发肿瘤体积、N分期、组织学分化程度、分割方案、辅助化疗以及性别。
对于声门上喉癌和真声带癌患者，原发肿瘤体积对放疗后的局部控制率以及放疗后无严重晚期并发症的局部控制率有显著影响。相比之下，口咽癌和下咽癌患者的局部控制率以及无严重并发症的局部控制率受肿瘤体积的影响较小。对总体人群的多因素分析显示，与放疗后局部控制概率显著相关的唯一参数是T分期。按原发部位分层的多因素分析显示，肿瘤体积对声门上癌（p = 0.0220）和声门癌（p = 0.0042）患者的局部控制有显著影响，但对扁桃体窝/扁桃体后柱（p = 0.0892）、舌根（p = 0.9493）、扁桃体前柱/软腭（p = 0.5909）和下咽癌（p = 0.2282）患者的局部控制无显著影响。
影响放疗后局部控制的最重要参数是T分期。原发肿瘤体积也显著影响声门上癌和声门癌的局部控制概率。
