Maillard S, Jovenin N, Cauchois A, Froissart D, Merol J C, Chays A, Nguyen T D
Service de radiothérapie, institut Jean-Godinot, 1, rue du Général-Koenig, 51100 Reims, France.
Cancer Radiother. 2005 Sep;9(5):285-92. doi: 10.1016/j.canrad.2005.05.004. Epub 2005 Sep 15.
A retrospective study to re-assess the indications for postoperative radiation therapy in squamous cell carcinoma of the larynx staged N0 after gross resection.
Between January 1975 and December 2000, 166 patients with squamous cell carcinoma of the larynx were treated by total laryngectomy with or without neck dissection. Surgery was completed by external radiotherapy delivering 45 to 65 Gy to the tumour bed and 45 to 50 Gy to cervical lymphatic chains. Minimal follow-up was 36 months and median follow-up was 98 months.
The rate of nodal recurrence was 6% (median time for relapse was 9 months). The survival rates at 1, 2, 3 and 5 years were 93.5, 84, 80 and 69% respectively, with a 8 year 3 month median survival. The univariate analysis showed 4 parameters, which significantly increased the risk of local recurrence: the medical necessity for immediate tracheotomy, the subglottic involvement, the involvement of the whole larynx and the presence of lymphatic embols in the neck dissection. There was no statistically significant difference between the patients with or without a neck dissection. Fifty-nine secondary cancers were observed, 15 of them occurring in the head and neck area. The late complications consisted of cervical subcutaneous fibrosis (7%), oesophageal stricture (4%), oeso-tracheal fistula (l%), hypothyroidism (3%), bone necrosis (1%).
Prophylactic cervical radiotherapy in laryngeal cancers resulted in 6% cervical node recurrence rate. This value may represent the maximal rate to accept if one would favour new therapeutic strategies based on restricted indications for radiotherapy.
进行一项回顾性研究，以重新评估喉鳞状细胞癌N0期在大体切除术后的术后放疗指征。
1975年1月至2000年12月期间，166例喉鳞状细胞癌患者接受了全喉切除术，部分患者同时行或不行颈部清扫术。手术完成后，对肿瘤床进行45至65 Gy的外照射放疗，对颈部淋巴链进行45至50 Gy的外照射放疗。最短随访时间为36个月，中位随访时间为98个月。
淋巴结复发率为6%（复发中位时间为9个月）。1年、2年、3年和5年生存率分别为93.5%、84%、80%和69%，中位生存时间为8年3个月。单因素分析显示有4个参数显著增加了局部复发风险：即刻气管切开的医疗必要性、声门下受累、全喉受累以及颈部清扫术中存在淋巴栓子。行颈部清扫术和未行颈部清扫术的患者之间无统计学显著差异。观察到59例继发癌，其中15例发生在头颈部区域。晚期并发症包括颈部皮下纤维化（7%）、食管狭窄（4%）、食管气管瘘（1%）、甲状腺功能减退（3%）、骨坏死（1%）。
喉癌预防性颈部放疗导致颈部淋巴结复发率为6%。如果倾向于基于放疗受限指征的新治疗策略，该值可能代表可接受的最大复发率。
