Mendenhall W M, Parsons J T, Stringer S P, Cassisi N J, Million R R
Dept. of Radiation Oncology, University of Florida, College of Medicine, Gainesville.
Int J Radiat Oncol Biol Phys. 1992;23(4):725-32. doi: 10.1016/0360-3016(92)90644-w.
One-hundred eighteen patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated with curative intent between March 1965 and November 1988 at the University of Florida. All patients were observed for at least 2 years and 83% were observed for 5 or more years. Fifty-three patients were treated with irradiation alone and 65 patients were treated with surgery alone (32) or combined with irradiation (33). Thirty-two patients treated with irradiation alone had twice-daily fractionation and the remainder had once-daily fractionation. The local-regional control rates, including patients successfully salvaged after a local-regional recurrence, were 81% after irradiation alone and 81% after surgery alone or combined with adjuvant irradiation. The local control rates for patients treated with irradiation alone were 53% after once-daily fractionation and 71% after twice-daily fractionation. There was no relationship between vocal cord mobility at 5000 cGy, at the end of radiotherapy, or at 1 month after treatment and subsequent local control. The 5-year cause-specific survival rates were 74% for patients treated with irradiation alone and 63% for patients treated surgically. The incidence of severe complications, including those associated with salvage procedures, was 15% for both treatment groups. The rates of laryngeal voice preservation were 66% after irradiation alone and 2% after surgery. Irradiation alone for selected patients with T3 glottic cancer resulted in similar rates of local-regional control, survival, and severe complications, with a significantly higher likelihood of voice preservation, compared with surgery.
1965年3月至1988年11月期间，佛罗里达大学对118例未经治疗的声门型T3期鳞状细胞癌患者进行了根治性治疗。所有患者均接受了至少2年的观察，83%的患者接受了5年或更长时间的观察。53例患者仅接受放疗，65例患者仅接受手术（32例）或手术联合放疗（33例）。仅接受放疗的32例患者采用每日两次分割放疗，其余患者采用每日一次分割放疗。局部区域控制率，包括局部区域复发后成功挽救的患者，单纯放疗后为81%，单纯手术或手术联合辅助放疗后为81%。单纯放疗患者的局部控制率，每日一次分割放疗后为53%，每日两次分割放疗后为71%。放疗结束时、5000 cGy时或治疗后1个月时的声带活动度与随后的局部控制之间没有关系。单纯放疗患者的5年病因特异性生存率为74%，手术治疗患者为63%。两个治疗组严重并发症的发生率，包括与挽救手术相关的并发症，均为15%。单纯放疗后的喉发音保留率为66%，手术治疗后为2%。与手术相比，对选定的声门型T3期癌症患者单纯放疗导致局部区域控制、生存率和严重并发症的发生率相似，但发音保留的可能性显著更高。
