Storper I S, Lee S P, Abemayor E, Juillard G
Division of Head and Neck Surgery, University of California, Los Angeles School of Medicine 90024-1624.
Am J Otolaryngol. 1993 Nov-Dec;14(6):426-31. doi: 10.1016/0196-0709(93)90118-q.
This study was undertaken to elucidate the efficacy of external beam irradiation in the treatment of head and neck malignant melanoma, in comparison with the efficacy of surgical excision and the efficacy of surgical excision combined with external beam irradiation.
A retrospective chart review of all patients seen at the Department of Radiation Oncology at the University of California at Los Angeles Medical Center with the diagnosis of head and neck melanoma from 1973 to 1992 was conducted. Using chi 2 analysis, survival rates were examined for patients treated with excision alone, irradiation alone, and both excision and irradiation.
Patients were treated with primary excision (96%), salvage excision for recurrent or residual disease (47%), primary irradiation (9%), post-surgical-planned irradiation (22%), adjuvant chemotherapy (45%), and adjuvant immunotherapy (36%). The overall survival rate for the entire group was 29%. For patients with recurrent or regional disease, survival rates were 37% for those treated with excision in combination with irradiation, 20% for those treated with irradiation alone, and 19% for those treated with excision. Whereas the differences among groups were not statistically significant, the biologic implication is that external beam irradiation is effective in controlling regional disease, since the tumors treated with irradiation alone or excision in combination with irradiation were larger and more aggressive than those treated with excision alone.
External beam irradiation is of benefit in treating patients with melanoma who are ineligible for salvage surgery or as an adjunctive modality in situations where the risk of recurrence is high.
本研究旨在阐明外照射治疗头颈部恶性黑色素瘤的疗效，并与手术切除以及手术切除联合外照射的疗效进行比较。
对1973年至1992年在加州大学洛杉矶分校医学中心放射肿瘤学系就诊且诊断为头颈部黑色素瘤的所有患者进行回顾性病历审查。使用卡方分析，对单纯切除、单纯照射以及切除联合照射治疗的患者生存率进行检查。
患者接受了原发灶切除（96%）、对复发或残留病灶的挽救性切除（47%）、原发灶照射（9%）、术后计划性照射（22%）、辅助化疗（45%）以及辅助免疫治疗（36%）。整个组的总生存率为29%。对于复发或局部病变患者，切除联合照射治疗的患者生存率为37%，单纯照射治疗的患者为20%，单纯切除治疗的患者为19%。尽管组间差异无统计学意义，但生物学意义在于外照射在控制局部病变方面有效，因为单纯照射或切除联合照射治疗的肿瘤比单纯切除治疗的肿瘤更大且更具侵袭性。
外照射对不适于挽救性手术的黑色素瘤患者有益，或在复发风险高的情况下作为辅助治疗手段。
