Foote R L, Olsen K D, Meland N B, Schaid D J, Kunselman S M
Division of Radiation Oncology, Mayo Clinic Rochester, MN 55905.
Mayo Clin Proc. 1994 Feb;69(2):122-30. doi: 10.1016/s0025-6196(12)61037-4.
The objectives of this study were to determine whether the combination of complex tumor-ablative surgery and microvascular free tissue transfer reconstruction delays the onset of postoperative radiation therapy, whether free tissue transfers are lost after a course of radiation therapy, and what patterns of tumor recurrence and survival rates are present in patients who undergo this type of multidisciplinary treatment.
A retrospective review was conducted in 37 patients who underwent tumor-ablative surgery and reconstruction between November 1987 and August 1991.
Of the 30 men and 7 women who underwent tumor-ablative surgery, microvascular free tissue transfer reconstruction, and postoperative radiation therapy, recurrent or T4 primary tumors were treated in 84%. Sixty-two percent of the patients had nodal metastatic disease. The median dose of postoperative irradiation was 60 Gy (range, 32.4 to 76.8). Follow-up in all patients was until death (21 patients) or for a median of 17.5 months (range, 4.1 to 43.2).
The median duration of overall survival and the 2-year overall survival rate were 17 months and 46%, respectively. For cause-specific survival, the median duration and 2-year rate were 17 months and 50%, respectively. Local recurrence developed in 8 patients, neck recurrence in 10, and distant metastatic disease in 11. No microvascular free tissue transfers failed.
Radiation therapy can begin in most patients within 8 weeks postoperatively, microvascular free tissue transfers seem to tolerate postoperative radiation therapy well at the doses administered, and the rates of local and neck control are reasonable relative to the advanced stage of the cancers treated.
本研究的目的是确定复杂肿瘤切除手术与微血管游离组织移植重建相结合是否会延迟术后放疗的开始时间，放疗疗程后游离组织移植是否会失败，以及接受这种多学科治疗的患者的肿瘤复发模式和生存率如何。
对1987年11月至1991年8月期间接受肿瘤切除手术和重建的37例患者进行回顾性研究。
在接受肿瘤切除手术、微血管游离组织移植重建及术后放疗的30例男性和7例女性患者中，84%为复发性或T4期原发性肿瘤。62%的患者有淋巴结转移疾病。术后放疗的中位剂量为60 Gy（范围32.4至76.8）。所有患者的随访至死亡（21例患者）或中位随访17.5个月（范围4.1至43.2）。
总生存的中位持续时间和2年总生存率分别为17个月和46%。病因特异性生存的中位持续时间和2年率分别为17个月和50%。8例患者出现局部复发，10例出现颈部复发，11例出现远处转移疾病。没有微血管游离组织移植失败。
大多数患者术后8周内即可开始放疗，微血管游离组织移植在所用剂量下似乎能很好地耐受术后放疗，相对于所治疗癌症的晚期阶段，局部和颈部控制率是合理的。
