Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
Am J Otolaryngol. 2011 Jul-Aug;32(4):286-90. doi: 10.1016/j.amjoto.2010.05.004. Epub 2010 Aug 17.
The purpose of this study is to present our experience treating patients with squamous cell carcinoma (SCC) from an unknown head and neck primary site and to determine whether a policy change eliminating the larynx and hypopharynx from the radiotherapy (RT) portals has impacted outcome.
One hundred seventy-nine patients received definitive RT with or without a neck dissection for SCC from an unknown head and neck primary site. RT was delivered to the ipsilateral neck alone or both sides of the neck and, usually, the potential mucosal primary sites. The median mucosal dose was 5670 cGy. The median neck dose was 6500 cGy. One hundred nine patients (61%) received a planned neck dissection.
Mucosal control at 5 years was 92%. The mucosal control rate in patients with RT limited to the nasopharynx and oropharynx was 100%. The 5-year neck-control rates were as follows: N(1), 94%; N(2a), 98%; N(2b), 86%; N(2c), 86%; N(3), 57%; and overall, 81%. The 5-year cause-specific survival rates were as follows: N(1), 94%; N(2a), 88%; N(2b), 82%; N(2c), 71%; N(3), 48%; and overall, 73%. The 5-year overall survival rates were as follows: N(1), 50%; N(2a), 70%; N(2b), 59%; N(2c), 45%; N(3), 34%; and overall, 52%. Eleven patients (7%) developed severe complications.
RT alone or combined with neck dissection results in a high probability of cure with a low risk of severe complications. Eliminating the larynx and hypopharynx from the RT portals did not compromise outcome and likely reduces treatment toxicity.
本研究旨在介绍我们治疗来自头颈部未知原发灶的鳞状细胞癌（SCC）患者的经验，并确定是否改变将喉和下咽排除在放射治疗（RT）野之外的治疗策略会影响治疗效果。
179 例来自头颈部未知原发灶的 SCC 患者接受了根治性 RT 治疗，其中部分患者同时接受了颈部清扫术。RT 仅用于单侧颈部或双侧颈部和（通常）潜在的黏膜原发灶。黏膜中位剂量为 5670cGy，颈部中位剂量为 6500cGy。109 例（61%）患者接受了计划的颈部清扫术。
5 年时黏膜控制率为 92%。接受 RT 限于鼻咽和口咽的患者黏膜控制率为 100%。5 年颈部控制率如下：N（1）区为 94%，N（2a）区为 98%，N（2b）区为 86%，N（2c）区为 86%，N（3）区为 57%，总体为 81%。5 年无病生存率如下：N（1）区为 94%，N（2a）区为 88%，N（2b）区为 82%，N（2c）区为 71%，N（3）区为 48%，总体为 73%。5 年总生存率如下：N（1）区为 50%，N（2a）区为 70%，N（2b）区为 59%，N（2c）区为 45%，N（3）区为 34%，总体为 52%。11 例（7%）患者发生严重并发症。
RT 单独或联合颈部清扫术可获得较高的治愈率，且严重并发症风险较低。将喉和下咽排除在 RT 野之外并未影响治疗效果，可能还降低了治疗毒性。
