Foote R L, Olsen K D, Kunselman S J, Schaid D J, Buskirk S J, Grado G L, Earle J D
Division of Radiation Oncology, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1992 Jul;67(7):629-36. doi: 10.1016/s0025-6196(12)60716-2.
Between January 1975 and December 1985, 45 patients with carcinoma in situ or invasive squamous cell carcinoma of the glottic larynx received radiation therapy at the Mayo Clinic. Local control in the entire group of 45 patients was 84% (in 6 of 6 with carcinoma in situ and in 32 of 39 with invasive cancers). Three of seven patients (43%) with local recurrences underwent successful larynx-preserving surgical procedures; thus, the rate of laryngeal preservation was 91%. In our study of several treatment factors, including the duration of treatment, type of treatment (continuous course versus split course), photon energy (60Co versus 4-MV photons versus 6-MV photons), total dose, and dose per fraction, we found that only total dose of 6,300 cGy or more was associated with significantly improved local control (in 35 of 38 patients [92%]). Two patients (4%) died of uncontrolled delayed nodal metastases, one of which was preceded by a local recurrence. Severe laryngeal edema developed in two patients, associated with recurrent glottic carcinoma in one of them. No larynx was lost because of complications. In our current treatment recommendations, patients receive a total dose of 6,300 cGy in 28 fractions of 225 cGy each, administered in a continuous course with use of 6-MV photons.
1975年1月至1985年12月期间，45例声门原位癌或浸润性鳞状细胞癌患者在梅奥诊所接受了放射治疗。45例患者的总体局部控制率为84%（6例原位癌患者中有6例，39例浸润性癌患者中有32例）。7例局部复发患者中有3例（43%）接受了成功的保喉手术；因此，保喉率为91%。在我们对几个治疗因素的研究中，包括治疗持续时间、治疗类型（连续疗程与分割疗程）、光子能量（60钴与4兆伏光子与6兆伏光子）、总剂量和分次剂量，我们发现只有总剂量达到6300厘戈或更高时，局部控制才有显著改善（38例患者中有35例[92%]）。2例患者（4%）死于未控制的延迟性淋巴结转移，其中1例之前有局部复发。2例患者出现严重喉水肿，其中1例与复发性声门癌有关。没有患者因并发症而失去喉部。在我们目前的治疗建议中，患者接受的总剂量为6300厘戈，分28次给予，每次225厘戈，采用6兆伏光子连续照射。
