Parsons J T, Mendenhall W M, Cassisi N J, Isaacs J H, Million R R
University of Florida College of Medicine, Gainesville 32610.
Int J Radiat Oncol Biol Phys. 1988 Apr;14(4):649-58. doi: 10.1016/0360-3016(88)90085-5.
Between March 1978 and April 1984, 144 patients with 148 moderately advanced to advanced primary squamous cell carcinomas of the head and neck received treatment with curative intent with twice-a-day irradiation (120 cGy/fraction, 4-6 hour interfraction interval). Eighty-eight percent of the patients had AJCC Stage III-IV cancers. One hundred and thirty-two patients received irradiation alone to the primary site with or without radical neck dissection, with surgery reserved for salvage. The total doses administered were 7440-7920 cGy in the majority of instances. In 19 patients with oropharyngeal lesions, a 1000-1500 cGy radium needle boost was added after the basic dose. Twelve patients received preoperative irradiation (5040-6000 cGy) followed by primary resection and radical neck dissection. Local control results following irradiation alone to total doses of greater than 7000 cGy with minimum 2-year follow-up were 25/31 (81%), 38/50 (76%), and 5/25 (20%) for T2, T3, and T4 cancers, respectively. Local control rates did not correlate well with total dose. Local control following preoperative irradiation plus primary resection was obtained in 4 of 5 T3 and 2 of 3 T4 primary lesions. The 5-year actuarial rates of neck control were 100% for N0 (45 patients), 90% for N1 (25 patients), 77% for N2 (23 patients), 50% for N3A (9 patients), and 70% for N3B (42 patients). The 5-year actuarial rates of continuous disease control above the clavicles were 73% for Stage III, 64% for Stage IVA, and 32% for Stage IVB. The actuarial 4-year rate of continuous disease control above the clavicles was 78% for Stage II. For patients whose disease was controlled above the clavicles, distant metastases developed in 4% of patients with Stage II-III disease and in 18% of patients with Stage IV disease. Radiation complications following irradiation alone to the primary site correlated with total dose. Complications of planned neck dissection(s) were acceptable. Complications of salvage surgery at the primary site were similar to those seen in patients treated once a day. The actuarial 5-year survival rates, according to modified AJCC stage, were 59% for Stage III, 37% for Stage IVA, and 23% for Stage IVB. The actuarial 4-year survival rate for Stage II was 69%. Compared to historical control groups treated with once-a-day, continuous-course irradiation at our institution, twice-a-day treatment has produced local control results that are higher by 10-15 percentage points.
1978年3月至1984年4月期间，144例患有148例中晚期至晚期原发性头颈部鳞状细胞癌的患者接受了旨在治愈的每日两次照射治疗（每次分割剂量120 cGy，两次分割间隔4 - 6小时）。88%的患者患有美国癌症联合委员会（AJCC）III - IV期癌症。132例患者仅对原发部位进行照射，伴或不伴根治性颈清扫术，手术仅用于挽救治疗。在大多数情况下，给予的总剂量为7440 - 7920 cGy。19例口咽病变患者在给予基本剂量后，追加了1000 - 1500 cGy的镭针增敏照射。12例患者接受了术前照射（5040 - 6000 cGy），随后进行原发灶切除和根治性颈清扫术。单独照射至总剂量大于7000 cGy且至少随访2年的局部控制结果显示，T2、T3和T4期癌症的局部控制率分别为25/31（81%）、38/50（76%）和5/25（20%）。局部控制率与总剂量的相关性不佳。术前照射加原发灶切除后的局部控制情况为，5例T3期原发灶中有4例、3例T4期原发灶中有2例实现了局部控制。N0期（45例患者）的5年颈部控制精算率为100%，N1期（25例患者）为90%，N2期（23例患者）为77%，N3A期（9例患者）为50%，N3B期（42例患者）为70%。锁骨以上持续疾病控制的5年精算率，III期为73%，IVA期为64%，IVB期为32%。II期锁骨以上持续疾病控制的4年精算率为78%。对于疾病在锁骨以上得到控制的患者，II - III期疾病患者中有4%发生远处转移，IV期疾病患者中有18%发生远处转移。仅对原发部位进行照射后的放疗并发症与总剂量相关。计划性颈清扫术的并发症是可接受的。原发部位挽救性手术的并发症与每日照射一次的患者所见相似。根据改良AJCC分期，5年精算生存率，III期为59%，IVA期为37%，IVB期为23%。II期的4年精算生存率为69%。与我院历史对照组接受每日一次连续疗程照射相比，每日两次照射的局部控制结果提高了10 - 15个百分点。
