Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Radiology, Anjyo Kosei Hospital, Anjyo, Japan.
Nagoya J Med Sci. 2023 May;85(2):241-254. doi: 10.18999/nagjms.85.2.241.
The local control rates of T1 bulky and T2 glottic carcinoma treated via radiation therapy alone are unsatisfactory; thus, we aimed to evaluate the efficacy and safety of our treatment protocol for early glottic carcinoma. Patients with early glottic squamous cell carcinoma treated via radiation therapy from January 2007 to November 2019 were reviewed. Patients were treated with: 63-67.5 Gy/28-30 fractions of radiation therapy alone for T1 non-bulky; concurrent chemoradiotherapy with S-1 and 60 Gy/30 fractions for T1 bulky and T2 favorable; and concurrent chemoradiotherapy with high-dose cisplatin and 66-70 Gy/33-35 fractions for T2 unfavorable glottic carcinoma. Local failure rates were estimated using the cumulative incidence function, overall and disease specific survival rates were estimated using Kaplan-Meier analysis, and adverse events were evaluated. Eighty patients were analyzed; the median age was 69.5 (range, 26-90) years, the median follow-up time for survivors was 40.1 (range, 1.9-128.4) months, and the 3-year local failure, disease specific survival, and overall survival rates were 5.8%, 98.3%, and 94.4%, respectively. In T1 bulky and T2 cases, the local failure rate was significantly lower in the concurrent chemoradiotherapy than in the radiation therapy alone group. Grade 3 acute dermatitis and mucositis were noted in nine and four patients, respectively. There were no acute adverse events of Grade 4 or higher, or late adverse events of Grade 2 or higher. The treatment protocol was effective and well-tolerated; thus, the efficacy of concurrent chemoradiotherapy was suggested in T1 bulky and T2 cases.
单纯放疗治疗 T1 巨块型和 T2 声门型喉癌的局部控制率不理想；因此，我们旨在评估我们治疗早期声门型喉癌的治疗方案的疗效和安全性。回顾了 2007 年 1 月至 2019 年 11 月期间接受单纯放疗治疗的早期声门型鳞状细胞癌患者。患者接受以下治疗：T1 非巨块型给予 63-67.5Gy/28-30 次分割放疗；T1 巨块型和 T2 有利型给予 S-1 同期化疗联合 60Gy/30 次分割放疗；T2 不利型声门型喉癌给予顺铂高剂量同期化疗联合 66-70Gy/33-35 次分割放疗。采用累积发生率函数估计局部失败率，采用 Kaplan-Meier 分析估计总生存率和疾病特异性生存率，评估不良反应。分析了 80 例患者；中位年龄为 69.5 岁（范围，26-90 岁），幸存者的中位随访时间为 40.1 个月（范围，1.9-128.4 个月），3 年局部失败、疾病特异性生存率和总生存率分别为 5.8%、98.3%和 94.4%。在 T1 巨块型和 T2 型病例中，同期放化疗组的局部失败率明显低于单纯放疗组。9 例和 4 例患者分别出现 3 级急性皮炎和粘膜炎。无 4 级或以上急性不良反应，或 2 级或以上迟发性不良反应。该治疗方案有效且耐受性良好；因此，建议在 T1 巨块型和 T2 型病例中采用同期放化疗。
