Choi Seungtaek, Schwartz David L, Farwell D Greg, Austin-Seymour Mary, Futran Neal
Department of Radiation Oncology, University of Washington, Seattle, USA.
Arch Otolaryngol Head Neck Surg. 2004 Nov;130(11):1308-12. doi: 10.1001/archotol.130.11.1308.
To determine whether external beam radiation therapy (XRT), administered either before or after surgery, increases the rate and/or severity of local postoperative complications in patients with head and neck cancer who undergo microvascular free flap reconstruction.
Retrospective cohort study.
University of Washington Medical Center, Seattle, a tertiary care hospital.
A total of 100 consecutive patients underwent fibular free flap reconstruction of the mandible. The study cohort was divided according to radiation treatment status: (1) no XRT (28 patients), (2) preoperative XRT (37 patients), and (3) postoperative XRT (35 patients). The median follow-up after surgery was 11 months (range, 1-89 months).
Rate and severity of local postoperative complications.
Fifty-four patients (54%) had at least 1 postoperative complication. There were no differences among the 3 XRT subgroups in the overall proportion of patients with complications of any severity (15 [54%] of 28 patients in the no XRT group, 24 [65%] of 37 patients in the preoperative XRT group, and 16 [46%] of 35 patients in the postoperative XRT group; P = .26, chi(2) analysis). There were also no differences seen when mild and severe complication rates were specifically examined (P = .58 and P = .10, respectively). No case of complete flap loss was observed. We noted no significant correlations between the rate of postoperative complications and the following covariates: total radiation dose, size of radiation field, disease stage, exposure to chemotherapy, presence of serious medical comorbidities, patient age, or history of tobacco use.
Our experience suggests that XRT can be safely administered before or after surgery to patients undergoing head and neck free flap reconstruction at an experienced surgical referral center. Postoperative complication rates were not significantly affected by administration, timing, dose, or extent of XRT.
确定在接受微血管游离皮瓣重建的头颈癌患者中，术前或术后进行的外照射放疗（XRT）是否会增加局部术后并发症的发生率和/或严重程度。
回顾性队列研究。
华盛顿大学医学中心，西雅图，一家三级医疗医院。
共有100例连续患者接受了下颌骨腓骨游离皮瓣重建。研究队列根据放疗状态分为：（1）未接受XRT（28例患者），（2）术前XRT（37例患者），以及（3）术后XRT（35例患者）。术后中位随访时间为11个月（范围1 - 89个月）。
局部术后并发症的发生率和严重程度。
54例患者（54%）至少发生1种术后并发症。在任何严重程度并发症患者的总体比例方面，3个XRT亚组之间无差异（未接受XRT组28例患者中有15例[54%]，术前XRT组37例患者中有24例[65%]，术后XRT组35例患者中有16例[46%]；P = 0.26，卡方分析）。在分别检查轻度和重度并发症发生率时也未发现差异（分别为P = 0.58和P = 0.10）。未观察到皮瓣完全坏死的病例。我们注意到术后并发症发生率与以下协变量之间无显著相关性：总放疗剂量、放疗野大小、疾病分期、化疗暴露、严重内科合并症的存在、患者年龄或吸烟史。
我们的经验表明，在经验丰富的外科转诊中心，对于接受头颈游离皮瓣重建的患者，可在术前或术后安全地进行XRT。XRT的给药、时机、剂量或范围对术后并发症发生率无显著影响。
