Howell-Burke D, Peters L J, Goepfert H, Oswald M J
Department of Clinical Radiotherapy, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Arch Otolaryngol Head Neck Surg. 1990 Jul;116(7):830-5. doi: 10.1001/archotol.1990.01870070078014.
The records of all patients with T2, NO squamous cell carcinoma of the true vocal cords treated with definitive radiotherapy at The University of Texas M. D. Anderson Cancer Center between 1970 and 1985 were analyzed to investigate treatment outcome, prognostic factors associated with tumor recurrence, and the potential impact of improved initial treatment on patient survival. There were 114 patients (male to female ratio, 13:1) with a median age of 62 years at presentation. All were treated with external beam irradiation to a modal dose of 70 Gy in 35 fractions over 7 weeks. The median field size was 25 cm2 and no elective treatment to the neck was routinely given. The crude recurrence rate after definitive radiotherapy was 32%. Of the 37 local regional failures, 32 were in the larynx only, 3 in the neck, and 2 in both the larynx and the neck. All patients who had recurrence after radiotherapy underwent salvage procedures, which increased the ultimate control rate above the clavicles to 94%. Overall and disease-specific survival rates at 5 years were 69% and 92%, respectively. Fifty patients died: 7 of laryngeal cancer, 2 of complications of salvage surgery, 13 of unrelated second cancers, and 28 of other intercurrent disease. The prospects for improved survival through more effective initial treatment of this stage of glottic cancer are therefore very limited. Significant complications of radiotherapy occurred in only 4 patients (3.5%), and overall, 74% of patients retained a functional larynx. Analysis of a wide variety of patient-, tumor-, and treatment-related variables failed to identify any statistically significant prognostic factors.(ABSTRACT TRUNCATED AT 250 WORDS)
对1970年至1985年间在德克萨斯大学MD安德森癌症中心接受根治性放疗的所有T2、N0期真性声带鳞状细胞癌患者的记录进行分析，以研究治疗结果、与肿瘤复发相关的预后因素，以及改进初始治疗对患者生存的潜在影响。共有114例患者（男女比例为13:1），就诊时中位年龄为62岁。所有患者均接受外照射，模式剂量为70 Gy，分35次在7周内完成。中位照射野面积为25 cm²，常规不对颈部进行选择性治疗。根治性放疗后的粗复发率为32%。在37例局部区域复发中，32例仅发生在喉部，3例发生在颈部，2例同时发生在喉部和颈部。所有放疗后复发的患者均接受了挽救性治疗，这使得锁骨以上区域的最终控制率提高到了94%。5年总生存率和疾病特异性生存率分别为69%和92%。50例患者死亡：7例死于喉癌，2例死于挽救性手术并发症，13例死于无关的第二原发癌，28例死于其他并发疾病。因此，通过更有效的初始治疗来提高声门癌这一阶段患者生存率的前景非常有限。仅4例患者（3.5%）发生了严重的放疗并发症，总体而言，74%的患者保留了功能正常的喉部。对各种与患者、肿瘤和治疗相关的变量进行分析，未能确定任何具有统计学意义的预后因素。（摘要截断于250字）
