Amemiya K, Shibuya H, Yoshimura R, Okada N
Departments of Radiology, Tokyo Medical and Dental University, 5-45, Yushima 1-chome, Bunkyo-ku, Tokyo 113-8519, Japan.
Br J Radiol. 2005 Nov;78(935):1028-33. doi: 10.1259/bjr/86352309.
The purpose of this study was to determine the incidence and the results of treatment of cancer induced by radiotherapy for early stage (stage I and II) squamous cell carcinoma of the head and neck (SCH). The clinical records of 355 patients with early stage malignant lymphoma of the head and neck region treated by radiotherapy were reviewed, and then the records of 1358 patients with early stage SCH (oral cavity, 956; larynx, 154; oropharynx, 110; maxillary sinus, 86; lip, 20; epipharynx, 17; hypopharynx, 15) who underwent radiotherapy were reviewed. The disease-specific 10-year survival rate of the patients with 355 malignant lymphoma was 61%, and 5 cases of radiation-induced cancer occurred more than 8 years after irradiation. The crude incidence of radiation-induced cancer in the malignant lymphoma patients was 1.4%, and the 10-year probability by the actuarial life table method was 0.8%. The 10-year survival rate of the early stage SCH patients was 71%. The crude incidence of a second cancer in a previously irradiated field after an 8-year latent period (SCI) in the SCH patients was 1.8% (25/1358), and the 10-year probability was 1.6%. 12 SCIs were treated by surgery and 8 of those 12 patients (67%) resulted in success, whereas treatment by radiation resulted in failure in every other case. The risk of SCIs in the SCH group was higher than in the early stage malignant lymphoma group, although the difference was not statistically significant. The possibility of radiation-induced cancer in SCH is small, and the advantage of radiation therapy compares favourably with the risks of other treatments.
本研究的目的是确定早期（I期和II期）头颈部鳞状细胞癌（SCH）放射治疗诱发癌症的发生率及治疗结果。回顾了355例接受放射治疗的早期头颈部恶性淋巴瘤患者的临床记录，然后回顾了1358例接受放射治疗的早期SCH患者（口腔，956例；喉，154例；口咽，110例；上颌窦，86例；唇，20例；下咽，17例；下咽，15例）的记录。355例恶性淋巴瘤患者的疾病特异性10年生存率为61%，5例放射诱发癌发生在照射后8年以上。恶性淋巴瘤患者放射诱发癌的粗发病率为1.4%，采用精算生命表法计算的10年概率为0.8%。早期SCH患者的10年生存率为71%。SCH患者在8年潜伏期后（SCI）先前照射野中第二原发癌的粗发病率为1.8%（25/1358），10年概率为1.6%。12例SCI患者接受了手术治疗，其中12例患者中有8例（67%）治疗成功，而其他病例采用放射治疗均失败。SCH组SCI的风险高于早期恶性淋巴瘤组，尽管差异无统计学意义。SCH中放射诱发癌的可能性较小，放射治疗的优势与其他治疗风险相比具有优势。
