Cole D A, Patel P M, Matar J R, Kenady D E, Maruyama Y
Department of Radiation Medicine, University of Kentucky Medical Center, Lexington.
Arch Otolaryngol Head Neck Surg. 1994 Mar;120(3):260-3. doi: 10.1001/archotol.1994.01880270008002.
One hundred eighty-three patients with floor of the mouth cancer, of whom 162 were evaluable, were treated between 1962 and 1987. Most patients (139) received treatment with curative intent. Forty-seven received surgery only; 45 received radiotherapy (RT) only; 23 received preoperative RT and surgery; 24 received surgery and postoperative RT. A subset of 30 patients received brachytherapy and external beam RT. Overall survival rates were: surgery only, 90%/68% (2 years/5 years); RT only, 65%/45%; preoperative RT, 65%/43%; and postoperative RT, 78%/41%. Patients receiving surgery generally had lower stage disease and good performance status; RT patients generally had higher stage disease--(64% had stages III and IV disease). Patients receiving RT also had over twice the incidence of deaths from intercurrent disease. These were the contributing factors to the lower survival rate of the patients receiving RT. Disease-free survivals were similar between the groups. In contrast, locoregional control was better for patients receiving RT, particularly in the postoperative RT and brachytherapy groups. Locoregional control rates were: surgery only, 59%/52% (2 years/5 years); RT only, 78%/69%; preoperative RT, 75%/58%; postoperative RT, 80%/74%; and brachytherapy, 96%/89%. This advantage in locoregional control was marked in patients with advanced local disease and was evident at 2 years and beyond. Treatment approaches evolved during the study period toward the use of surgery only in lower stages and combined with RT (usually postoperative) in higher stages.
1962年至1987年间，对183例口底癌患者进行了治疗，其中162例可进行评估。大多数患者（139例）接受了根治性治疗。47例仅接受手术治疗；45例仅接受放射治疗（RT）；23例接受术前RT和手术；24例接受手术和术后RT。30例患者的一个亚组接受了近距离放疗和外照射RT。总生存率分别为：仅手术治疗，90%/68%（2年/5年）；仅RT治疗，65%/45%；术前RT治疗，65%/43%；术后RT治疗，78%/41%。接受手术治疗的患者一般疾病分期较低且身体状况良好；接受RT治疗的患者一般疾病分期较高（64%为III期和IV期疾病）。接受RT治疗的患者因并发疾病死亡的发生率也高出两倍多。这些是导致接受RT治疗患者生存率较低的因素。各组之间无病生存率相似。相比之下，接受RT治疗的患者局部区域控制更好，尤其是在术后RT治疗组和近距离放疗组。局部区域控制率分别为：仅手术治疗，59%/52%（2年/5年）；仅RT治疗，78%/69%；术前RT治疗，75%/58%；术后RT治疗，80%/74%；近距离放疗，96%/89%。这种局部区域控制优势在局部晚期疾病患者中很明显，在2年及以后更为显著。在研究期间，治疗方法逐渐演变为仅在较低分期使用手术，在较高分期则与RT（通常为术后）联合使用。
