Lohynska R, Slavicek A, Bahanan A, Novakova P
Department of Radiotherapy and Oncology, University Hospital Motol, 150 06 Prague, Czech Republic.
Neoplasma. 2005;52(6):483-8.
The aim of the study was to assess the impact of factors that could predict the probability of local failure in early laryngeal squamous cell carcinoma treated with curative radiotherapy. Sixty seven patients (12 women and 55 men) with laryngeal cancer stage I (47 patients) and stage II (20 patients) were treated from 1998 to 2003 with curative radiotherapy and retrospectively evaluated. Median follow-up was 36 months (3-80). Local relapse occurred in 10 patients (15%), regional lymphnodes relapse affected 2 patients. The median time between start of radiotherapy to recurrence was 13 months (3-48). Death due to cancer occurred in 4 patients (2 died from locoregional progression of the recurrence and 2 from distant metastases), whereas 7 patients died from non-cancer related causes. The 2-year overall survival rate was 90% and 5-year OS was 79%. The 2-year local control rate was 82% and 5-year local control was 79%. In the univariate analysis there was a statistically significant decrease in local control influenced by grading (p < 0.0001). High risk group of relapse encompassed patients with at least two negative factors: supraglottic tumor, women, radiotherapy prolongation by 3 or more days and high grade tumor and has 3 times worse local control than low risk group (p=0.0125). The highest risk of local recurrence was in the first three years after radiotherapy than later (p=0.0057). On multivariate analysis unfavourable prognostic factors for local control were gender (p=0.022), presence of 2 or more negative risk factors (p=0.018) and lengths of follow up (p=0.005). Radiation dose, stage, age, hemoglobin level and anterior commissure involvement were not significant factors for local control. Overall survival was affected both in the univariate and multivariate analysis by presence of local relapse (p < 0.005) and follow up duration (p < 0.02). Anemia had borderline significance for overall survival in univariate analysis (p=0.064), but in the multivariate analysis was significant unfavourable factor (p=0.008). Other studied factors (radiation dose, anterior commissure involvement and age) were not reaching level of statistical significant value for overall survival. Close follow up strategy is recommended for high risk group of patients with two or more risk factors especially in the first three years after radiation therapy.
本研究的目的是评估可预测接受根治性放疗的早期喉鳞状细胞癌局部失败概率的因素的影响。1998年至2003年期间，对67例喉癌患者（12例女性和55例男性）进行了根治性放疗，并进行回顾性评估，其中I期患者47例，II期患者20例。中位随访时间为36个月（3 - 80个月）。10例患者（15%）发生局部复发，2例患者出现区域淋巴结复发。放疗开始至复发的中位时间为13个月（3 - 48个月）。4例患者死于癌症（2例死于复发的局部区域进展，2例死于远处转移），7例患者死于非癌症相关原因。2年总生存率为90%，5年总生存率为79%。2年局部控制率为82%，5年局部控制率为79%。在单因素分析中，分级对局部控制有统计学显著影响（p < 0.0001）。复发高危组包括至少有两个阴性因素的患者：声门上肿瘤、女性、放疗延长3天或更长时间以及高级别肿瘤，其局部控制比低风险组差3倍（p = 0.0125）。放疗后前三年局部复发风险最高，之后风险降低（p = 0.0057）。多因素分析显示，局部控制的不良预后因素为性别（p = 0.022）、存在两个或更多阴性风险因素（p = 0.018）以及随访时间（p = 0.005）。放射剂量、分期、年龄、血红蛋白水平和前联合受累不是局部控制的显著因素。在单因素和多因素分析中，局部复发的存在（p < 0.005）和随访时间（p < 0.02）均影响总生存率。贫血在单因素分析中对总生存率有临界意义（p = 0.064），但在多因素分析中是显著的不良因素（p = 0.008）。其他研究因素（放射剂量、前联合受累和年龄）对总生存率未达到统计学显著水平。建议对有两个或更多风险因素的高危患者组进行密切随访，尤其是在放疗后的前三年。
