Reddy Sarada P, Hong Robert L, Nagda Suneel, Emami Bahman
Loyola-Hines Department of Radiotherapy, Loyola University Chicago, Maywood, IL 60153, USA.
Int J Radiat Oncol Biol Phys. 2007 Dec 1;69(5):1389-94. doi: 10.1016/j.ijrobp.2007.05.077. Epub 2007 Sep 14.
To evaluate the effect of tumor bulk on local control and survival of patients with T1 glottic cancer.
Effects of tumor bulk, T-stage, anterior-commissure involvement, treatment duration, and fraction size were analyzed in 208 patients; 136 had small tumors and 72 had bulky tumors. Anterior-commissure was involved in 54 patients. Treatment duration ranged from 39 to 64 days and fraction size ranged from 1.8 to 2.0 Gy. Median follow-up was 5.1 years.
Five-year actuarial local control rates were 86.1% and 91.4% after radiotherapy and salvage laryngectomy. On univariate analysis, local control rates were 92.6% and 73.6% for small and bulky tumors (p = 0.03), 89.6% and 75.9% for patients without and with anterior-commissure involvement (p = 0.01), 92.6% and 75.6% when treatment duration was <or=50 days and >50 days (p = 0.04), and 90.2% and 76.4% with 2 Gy and 1.8 Gy (p = 0.02) per fraction. On multivariate analysis, tumor bulk was the only significant factor that affected local control (p = 0.007). Ultimate local control rates after salvage were 97.1% and 80.5% for patients with small and bulky tumors. Disease-free survival rates at 5 years for small and bulky tumors were 96.3% and 84.7% (p = 0.001). Median duration to recurrence for small tumors was 30 months as compared with 11 months for bulky tumors.
Tumor bulk is a highly significant prognostic factor for radiation control of T1 glottic cancer. Patients with bulky tumors had lower local control and disease-free survival rates and shorter duration to recurrence than those with small tumors.
评估肿瘤大小对T1期声门癌患者局部控制率和生存率的影响。
分析了208例患者的肿瘤大小、T分期、前联合受累情况、治疗持续时间和分次剂量的影响；136例为小肿瘤患者，72例为大肿瘤患者。54例患者前联合受累。治疗持续时间为39至64天，分次剂量为1.8至2.0 Gy。中位随访时间为5.1年。
放疗和挽救性喉切除术后5年精算局部控制率分别为86.1%和91.4%。单因素分析显示，小肿瘤和大肿瘤的局部控制率分别为92.6%和73.6%（p = 0.03），无前联合受累和有前联合受累患者的局部控制率分别为89.6%和75.9%（p = 0.01），治疗持续时间≤50天和＞50天患者的局部控制率分别为92.6%和75.6%（p = 0.04），每次分次剂量为2 Gy和1.8 Gy患者的局部控制率分别为90.2%和76.4%（p = 0.02）。多因素分析显示，肿瘤大小是影响局部控制的唯一显著因素（p = 0.007）。小肿瘤和大肿瘤患者挽救治疗后的最终局部控制率分别为97.1%和80.5%。小肿瘤和大肿瘤患者5年无病生存率分别为96.3%和84.7%（p = 0.001）。小肿瘤复发的中位时间为30个月，而大肿瘤为11个月。
肿瘤大小是T1期声门癌放射治疗控制的一个高度显著的预后因素。大肿瘤患者的局部控制率和无病生存率较低，复发时间比小肿瘤患者短。
