Frezza G, Bunkheila F, Caliceti U, Gabbani M, Galuppi A, Guidetti A, Silvano M, Sorrenti G, Babini L
Istituto di Radioterapia L. Galvani, Università di Bologna.
Radiol Med. 1995 Jun;89(6):850-4.
A retrospective study was carried out on a series of 154 patients affected with vocal cord cancer in stage T1 treated with definitive radiotherapy April, 1979, to November, 1991. According to the 1992 TNM classification (UICC), 121 patients were classified as stage T1a and 33 patients as stage T1b. All patients were treated using parallel opposed fields of a 60 cobalt unit. Field size ranged from 16 to 30 square centimeters and the dose from 4400 to 7000 cGy, but only 15 patients received less than 6400 cGy. All patients were treated with once-daily fractionation (200 cGy/day). Follow-up ranges from 25 to 123 months; the median is 63 months. We observed 14 local recurrences (9.0%), all but one within 36 months from the end of treatment. Ten of 14 patients (71.4%) were rescued by surgery (8 patients underwent total laryngectomy and 2 conservative surgery); 13 patients were lost for intercurrent deaths. The incidence of recurrences is 7.4% for T1a patients (9/121) and 15.1% for T1b patients (5/33). The total dose does not seem to be related to relapse rate since recurrences were found in 6.6% of patients after a dose < 6400 cGy and in 9.3% of patients who had received higher doses. In our experience, field size did not affect, treatment results (< 25 cm2: 7.5% recurrences, > 25 cm2: 10.7%). Besides lesion volume, the main prognostic factor was overall treatment time. The incidence of failure was 3 times lower (5.8%) in the patients who completed the treatment within 7 weeks than in the patients whose treatment lasted more than 8 weeks (16.6%).
对1979年4月至1991年11月期间接受根治性放疗的154例T1期声带癌患者进行了一项回顾性研究。根据1992年TNM分类（UICC），121例患者被分类为T1a期，33例患者为T1b期。所有患者均使用60钴单位的平行相对野进行治疗。照射野面积为16至30平方厘米，剂量为4400至7000 cGy，但只有15例患者接受的剂量低于6400 cGy。所有患者均采用每日一次分割照射（200 cGy/天）。随访时间为25至123个月；中位数为63个月。我们观察到14例局部复发（9.0%），除1例外，均在治疗结束后36个月内复发。14例患者中有10例（71.4%）通过手术挽救（8例行全喉切除术，2例行保守手术）；13例患者因并发死亡失访。T1a期患者的复发率为7.4%（9/121），T1b期患者为15.1%（5/33）。总剂量似乎与复发率无关，因为剂量<6400 cGy的患者中6.6%出现复发，而接受较高剂量的患者中9.3%出现复发。根据我们的经验，照射野面积不影响治疗结果（<25 cm2：复发率7.5%，>25 cm2：复发率10.7%）。除病变体积外，主要的预后因素是总治疗时间。在7周内完成治疗的患者中，失败发生率比治疗持续超过8周的患者低3倍（5.8%比16.6%）。
