Weller S A, Goffinet D R, Goode R L, Bagshaw M A
AJR Am J Roentgenol. 1976 Feb;126(2):236-47. doi: 10.2214/ajr.126.2.236.
Three hundred and five patients with oropharyngeal carcinomas received linear accelerator radiation therapy at the Stanford University Medical Center between 1956 and 1973. All were staged by the TNM system, using the UICC Classification of 1962. Actuarial five year survival for patients with tonsil cancers ranged from 50% to 18% for those with T1 and T3 lesions, respectively. Disease-free survival was higher than actuarial survival for patients with T1 and T2 lesions, reflecting an alteration of the latter curves by deaths from intercurrent diseases and second primary malignancies. Actuarial survival for patients with base of the tongue carcinomas was approximately 35% for those with T1 and T2 primary lesions and 22% for patients with T3 carcinomas. Considering all oropharyngeal sites of involvement together, clinically involved cervical lymph nodes were controlled by radiation therapy alone in 60 of 91 patients with N1 nodal involvement (67%), in twelve of 25 with N2 neck disease (48%) and in 46% of those patients with N3 involvement (34 of 74). Eighty-nine percent of patients whose lymph nodes were not controlled by radiation therapy alone also had uncontrolled primary cancers. Over 90% of the patients whole cervical lymph nodes were initially uninvolved remained free of late nodal metastases if at least the regional (first echelon) lymph nodes were included in the primary treatment fields. The results of a randomized trial which compared surgery and radiation therapy alone and the two modalities in combination for the treatment of a limited number of patients with advanced cancers of the oropharynx, supraglottic larynx and hypopharynx suggest that surgery alone is not the treatment of choice.
1956年至1973年间，305例口咽癌患者在斯坦福大学医学中心接受了直线加速器放射治疗。所有患者均采用1962年国际抗癌联盟（UICC）分类的TNM系统进行分期。扁桃体癌患者的精算5年生存率，T1期病变患者为50%，T3期病变患者为18%。T1和T2期病变患者的无病生存率高于精算生存率，这反映了并发疾病和第二原发性恶性肿瘤导致的死亡对后一种曲线的改变。舌根癌患者的精算生存率，T1和T2期原发性病变患者约为35%，T3期癌患者为22%。综合考虑所有受累的口咽部位，91例N1期淋巴结受累患者中有60例（67%）、25例N2期颈部疾病患者中有12例（48%）以及74例N3期受累患者中有34例（46%）仅通过放射治疗就控制了临床受累的颈部淋巴结。仅放射治疗未能控制淋巴结的患者中，89%的患者原发性癌症也未得到控制。如果在原发治疗野中至少包括区域（第一梯队）淋巴结，超过90%最初颈部淋巴结未受累的患者没有出现晚期淋巴结转移。一项随机试验比较了手术、单纯放射治疗以及两种方式联合治疗少数晚期口咽癌、声门上喉癌和下咽癌患者的效果，结果表明单纯手术并非首选治疗方法。
