Suit H D, Westgate S J
Int J Radiat Oncol Biol Phys. 1986 Apr;12(4):453-8. doi: 10.1016/0360-3016(86)90052-0.
Estimates of the gain in survival, if all local failures were eliminated, indicate that many more patients could be cured provided the efficacy of treatment of the primary and regional disease were substantially improved. The expected gain in survival is assumed to be the gain in local control, less the loss due to distant metastases and intercurrent disease among the new local control subjects. The observed incidence of DM among local failure patients may be higher than among local control patients; this excess in incidence of DM is assumed to result from metastases established secondary to the persistent or recurring tumor. A powerful argument that higher local control rates would result in more cured patients is the high incidence of long-term survivors after salvage surgery for local failures. Examples of higher survival associated with more effective local therapy are presented from the literature for medulloblastoma, ependymoma, carcinoma of the oral cavity-oropharynx, carcinoma of the urinary bladder, carcinoma of the prostate and carcinoma of the rectum. For Stage I-II cancer of the breast, the reduction of an already low local failure rate by combining surgery and radiation has a very small impact. For tumors, such as, early stage breast cancer, where the possible decrease in local failure is small and the loss due to DM is high, a demonstrable gain in survival is not likely. The potential increase in number of survivors among the U.S. cancer population, if the primary-regional disease were regularly treated successfully, indicates large gains for patients with cancer of the uterine cervix, oral cavity-oropharynx, ovary, colo-rectum, non-oat cell cancer of lung, prostate cancer, and bladder cancer. These provide powerful bases for aggressive investigation of new approaches to improvement of local-regional therapies.
如果能消除所有局部复发，对生存获益的估计表明，倘若原发疾病和区域疾病的治疗效果能大幅提高，那么更多患者有望治愈。预计的生存获益假定为局部控制方面的获益减去新的局部控制组中因远处转移和并发疾病导致的损失。局部复发患者中观察到的远处转移发生率可能高于局部控制组患者；这种远处转移发生率的增加假定是由持续性或复发性肿瘤继发的转移所致。有力的证据表明，更高的局部控制率会带来更多治愈患者，即局部复发后挽救性手术后长期存活者的高发生率。文献中给出了髓母细胞瘤、室管膜瘤、口腔 - 口咽癌、膀胱癌、前列腺癌和直肠癌等因更有效的局部治疗而提高生存率的例子。对于Ⅰ - Ⅱ期乳腺癌，联合手术和放疗降低本就很低的局部复发率的影响非常小。对于像早期乳腺癌这类肿瘤，局部复发可能的降低幅度小而远处转移导致的损失大，不太可能有明显的生存获益。如果能成功常规治疗原发 - 区域疾病，美国癌症患者群体中幸存者数量的潜在增加表明，子宫颈癌、口腔 - 口咽癌、卵巢癌、结直肠癌、非小细胞肺癌、前列腺癌和膀胱癌患者将有巨大获益。这些为积极探索改善局部 - 区域治疗的新方法提供了有力依据。
