Brown J S, Shaw R J, Bekiroglu F, Rogers S N
Liverpool University, United Kingdom.
Br J Oral Maxillofac Surg. 2012 Sep;50(6):481-9. doi: 10.1016/j.bjoms.2011.08.014. Epub 2011 Dec 22.
Improved disease-free survival for oral squamous cell carcinoma (SCC) with the use of postoperative radiotherapy (PORT) has to be balanced against the risk of recurrence, the relative morbidity of radiotherapy, reduced options for treatment, and survival with recurrent disease. In the absence of randomised trials, a review of current evidence is timely because of increasing differences in outcome and response to treatment for cancers of the larynx, oropharynx, and oral cavity. From a search of 109 papers, 25 presented relevant data in tabular form, and reported local, regional, and total recurrence, and overall survival. Most data come from non-randomised studies that compared the effects of interventions with previous or historical information. A summary of the results shows local recurrence of 11%, 17%, and 15% for early, late, and all stages after operation alone, compared with 13%, 16%, and 19% after PORT. Regional recurrence is reported as 13%, 12%, and 11% for early, late, and all stages after operation alone compared with 6%, 11%, and 9% after PORT. Overall survival is reported as 76%, 74%, and 77% for operation alone compared with 65%, 62%, and 62% for early, late and all stages of oral SCC, respectively. It is acknowledged that this is a weak level of evidence as patients who have PORT probably have a high pathological-stage of disease. Knowing that PORT increases morbidity and reduces salvage rates and options for treating recurrent disease, this difference in overall survival emphasises the need for randomised studies or a re-evaluation of our current protocols.
口腔鳞状细胞癌（SCC）术后放疗（PORT）带来的无病生存期改善，必须与复发风险、放疗相关的相对发病率、治疗选择减少以及复发性疾病的生存率相权衡。由于喉癌、口咽癌和口腔癌在治疗结果和反应方面的差异日益增大，在缺乏随机试验的情况下，及时回顾当前证据很有必要。在检索的109篇论文中，25篇以表格形式呈现了相关数据，并报告了局部、区域和总复发率以及总生存率。大多数数据来自非随机研究，这些研究将干预措施的效果与先前或历史信息进行了比较。结果总结显示，单纯手术后早期、晚期和所有阶段的局部复发率分别为11%、17%和15%，而PORT后分别为13%、16%和19%。报告显示，单纯手术后早期、晚期和所有阶段的区域复发率分别为13%、12%和11%，而PORT后分别为6%、11%和9%。单纯手术的总生存率报告为76%、74%和77%，而口腔SCC早期、晚期和所有阶段PORT后的总生存率分别为65%、62%和62%。公认这是一个证据力度较弱的情况，因为接受PORT的患者可能疾病病理分期较高。鉴于PORT会增加发病率并降低挽救率以及复发性疾病的治疗选择，总生存率的这种差异凸显了进行随机研究或重新评估我们当前方案的必要性。
