Scher Eli D, Romesser Paul B, Chen Christine, Ho Felix, Wuu Yen, Sherman Eric J, Fury Matthew G, Wong Richard J, McBride Sean, Lee Nancy Y, Riaz Nadeem
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States.
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, United States.
Oral Oncol. 2015 Jul;51(7):709-15. doi: 10.1016/j.oraloncology.2015.04.007. Epub 2015 May 7.
While surgery with or without adjuvant radiation therapy (RT) is the standard of care for oral cavity cancer (OCC), a select group requires nonsurgical treatment. We provide a single-institution experience using definitive chemotherapy and RT for primary OCC.
We examined 73 patients with previously untreated, non-metastatic primary OCC treated definitively from 1990 to 2011. There were 39 male and 34 female, with a median age of 63 years (range, 35-89). The disease distribution was Stage I and II (7% each), Stage III (14%), and Stage IV (73%). Oral tongue was the most common (48%), followed by floor of mouth (19%), retromolar trigone (13.7%), and others (8.2%). Median tumor dose was 70 Gy. Sixty-two percent of patients (n=45) were treated with concurrent chemotherapy, predominantly platinum-based.
Median follow-up among surviving patients was 73.1 months (interquartile range 14.2-81.4 months). Actuarial 5-year overall survival was 15%. Incidences of locoregional and distant failures were 41.1% and 20.5%, respectively. Kaplan-Meier estimated 5-year rates of locoregional control and freedom from distant metastasis were 37% and 70%, respectively. Mucositis was the most common ⩾Grade 3 acute toxicity (49%). Incidences of Grade 3 late dysphagia and trismus were 15% and 13%, respectively.
This study demonstrates over 20 years of experience using definitive chemoradiation for OCC at our institution. Our results illustrate the challenges in treating patients with advanced disease who are not surgical candidates, and the need for adequate and early treatment to prevent distant disease and improve survival outcomes.
虽然手术联合或不联合辅助放疗（RT）是口腔癌（OCC）的标准治疗方法，但有一部分患者需要非手术治疗。我们提供了在单一机构使用确定性化疗和放疗治疗原发性OCC的经验。
我们研究了1990年至2011年期间接受确定性治疗的73例未经治疗、非转移性原发性OCC患者。其中男性39例，女性34例，中位年龄63岁（范围35 - 89岁）。疾病分布为I期和II期（各占7%），III期（14%），IV期（73%）。口腔舌部是最常见的部位（48%），其次是口底（19%）、磨牙后三角区（13.7%）和其他部位（8.2%）。中位肿瘤剂量为70 Gy。62%的患者（n = 45）接受了同步化疗，主要是铂类化疗。
存活患者的中位随访时间为73.1个月（四分位间距14.2 - 81.4个月）。5年总生存率为15%。局部区域和远处转移的发生率分别为41.1%和20.5%。Kaplan - Meier估计的5年局部区域控制率和无远处转移率分别为37%和70%。黏膜炎是最常见的≥3级急性毒性反应（49%）。3级晚期吞咽困难和牙关紧闭的发生率分别为15%和13%。
本研究展示了我们机构20多年来使用确定性放化疗治疗OCC的经验。我们的结果说明了治疗不适合手术的晚期疾病患者面临的挑战，以及进行充分和早期治疗以预防远处疾病和改善生存结果的必要性。
