Cole C J, Garden A S, Frankenthaler R A, Reece G P, Morrison W H, Ang K K, Peters L J
Department of Radiotherapy, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Cancer. 1995 May 1;75(9):2356-60. doi: 10.1002/1097-0142(19950501)75:9<2356::aid-cncr2820750927>3.0.co;2-c.
Free jejunal autografts increasingly are being used to repair the pharynx after resections of head and neck carcinomas. Doses of greater than 45 Gy are generally considered to be above the tolerance of the small bowel, whereas the dose range for effective postoperative radiotherapy of advanced head and neck cancers is between 57.6 Gy and 63 Gy. Between July 1988, and December, 1992, 29 patients at the M. D. Anderson Cancer Center were treated with a combination of resection of the advanced head and neck cancer, reconstruction with free jejunal autograft, and postoperative radiation. Planned reductions in postoperative doses due to the presence of the jejunum within the field were not made. This retrospective study analyzes the outcome of these patients with attention to survival, local-regional control, and complications.
Twenty-seven of the 29 study patients had squamous cell carcinoma of the larynx or pharynx; 24 of these patients had Stage III or Stage IV disease. Two patients had recurrent papillary thyroid carcinoma. The median number of days from surgery to the start of radiation was 34. Radiation doses to the tumor bed ranged from 50 Gy to 72 Gy. The median doses to the tumor bed and the jejunal autograft were both 63 Gy. Surviving patients were followed from 12 to 68 months (median, 20 months) from the time of their surgery.
The actuarial 2-year survival rate was 51%. Nine patients had local or regional recurrences above the clavicles. The 2-year local-regional control and freedom from relapse rates were 71 and 50%, respectively. The most severe complication during radiation was confluent mucositis in greater than 50% of the treated area, which developed in two patients. No patient developed a late complication related to the jejunal autograft.
Postoperative radiation to free jejunal autografts used for pharyngeal reconstruction can be delivered safely. Doses in this setting of 57.6 Gy to 63 Gy depending on the anticipated risk of recurrence based on clinical, surgical, and pathologic findings are recommended. The presence of a free jejunal autograft did not require a reduction of the desired doses used for patients with postoperatively irradiated head and neck cancer.
游离空肠自体移植越来越多地用于修复头颈部癌切除术后的咽部。大于45 Gy的剂量通常被认为超出小肠的耐受范围，而晚期头颈部癌术后有效放疗的剂量范围在57.6 Gy至63 Gy之间。1988年7月至1992年12月期间，MD安德森癌症中心的29例患者接受了晚期头颈部癌切除、游离空肠自体移植重建及术后放疗的联合治疗。未因野内有空肠而计划降低术后剂量。这项回顾性研究分析了这些患者的生存、局部区域控制和并发症情况。
29例研究患者中有27例患有喉或咽鳞状细胞癌；其中24例患者为Ⅲ期或Ⅳ期疾病。2例患者患有复发性乳头状甲状腺癌。从手术到开始放疗的中位天数为34天。肿瘤床的放疗剂量范围为50 Gy至72 Gy。肿瘤床和游离空肠自体移植的中位剂量均为63 Gy。存活患者从手术时起随访12至68个月（中位时间为20个月）。
精算2年生存率为51%。9例患者锁骨上方出现局部或区域复发。2年局部区域控制率和无复发病率分别为71%和50%。放疗期间最严重的并发症是超过50%治疗区域出现融合性黏膜炎，2例患者出现这种情况。没有患者出现与游离空肠自体移植相关的晚期并发症。
用于咽部重建的游离空肠自体移植术后放疗可以安全进行。根据临床、手术和病理结果预测的复发风险，建议在此情况下给予57.6 Gy至63 Gy的剂量。游离空肠自体移植的存在并不需要降低头颈部癌术后放疗患者所需的剂量。
