Brugère J, Rodriguez J, Point D, Thanh P
Service de Chirurgie Cervico-Faciale et O.R.L., Institut Curie, Paris.
Ann Otolaryngol Chir Cervicofac. 1987;104(7):541-4.
The surgery of the larynx in an irradiated neck changed since 30 years by an evolution of the radiotherapeutic technics and the surgical procedures. At the Curie Institute, from 1960 to 1986, 230 patients were operated with laryngectomy for failure of the first treatment (average doses: 70 Gy). 29 had partial laryngectomy. The feeding tube was removed before 6 weeks in 78% of the patients. 19 patients (8%) died in the 3 months after surgery (8 carotid blow-up). The crude survival rates are 70% at 1 yr, 42% at 3 tr, 37% at 5 yr. These rates are identical in patients with persistent disease two months after irradiation (90), in patients with recurrence (110) and for those with second primary in the larynx (21). 54% of T1 and T2 patients are NED at 3 yr and 47% at 5 yr. For T3 and T4 rates are only 22% and 17%. Best results are in glottic cancers (74% at 3 yr); poorest in advanced supra-glottic (17%). Salvage procedure is effective in larynx and neck in 62% of the patients. Early detection of a failure after irradiation is a major condition for the application of a protocol of definitive radiotherapy in laryngeal cancer.
由于放射治疗技术和外科手术方法的发展，接受过颈部放疗患者的喉部手术在过去30年发生了变化。在居里研究所，1960年至1986年间，230例患者因首次治疗失败（平均剂量：70 Gy）接受了喉切除术。29例行部分喉切除术。78%的患者在6周前拔除了饲管。19例患者（8%）在术后3个月内死亡（8例颈动脉破裂）。1年总生存率为70%，3年为42%，5年为37%。这些生存率在放疗后两个月疾病持续存在的患者（90例）、复发患者（110例）以及喉第二原发癌患者（21例）中是相同的。54%的T1和T2期患者3年无疾病生存，5年为47%。T3和T4期患者的这一比例仅为22%和17%。声门癌的治疗效果最佳（3年生存率74%）；晚期声门上癌最差（17%）。挽救性手术在62%的患者的喉部和颈部有效。放疗后早期发现失败是在喉癌中应用确定性放疗方案的主要条件。
