Fein D A, Mendenhall W M, Parsons J T, Stringer S P, Cassisi N J, Million R R
Department of Radiation Oncology, University of Florida Health Science Center, Gainesville 32610-0385.
Int J Radiat Oncol Biol Phys. 1993 Aug 1;26(5):751-7. doi: 10.1016/0360-3016(93)90488-h.
To determine whether a modification in treatment technique and the routine use of twice-daily fractionation have influenced the likelihood of local control in carcinomas of the hypopharyngeal and/or oropharyngeal wall.
Between October 1964 and July 1990, 99 patients with invasive, previously untreated T1-T4 squamous cell carcinoma of the pharyngeal wall were treated with continuous-course, external-beam radio-therapy with curative intent at the University of Florida. All patients had a minimum 2-year follow-up.
The 2-year local control rates for patients treated with once-daily vs. twice-daily fractionation were T1, 100% each; T2, 67% vs. 92%; T3, 43% vs. 80%; and T4, 17% vs. 50%. The 2-year local control rates for patients treated with our former technique (posterior border placed at middle of the vertebral body when the portals were reduced off the spinal cord) vs. our current, modified technique (posterior border placed at posterior edge of the vertebral body) were T1, 100% each; T2, 57% vs. 100%; T3, 46% vs. 73%; and T4, 29% vs. 75%. The parameters of T stage, fractionation schedule, primary site, (oropharynx vs. hypopharynx) treatment technique, and lateral vs. posterior pharyngeal wall location were evaluated in a multivariate analysis for the end point of local control. T stage (p = .003), fractionation schedule (p = .001), and primary site (p = .028) were of independent prognostic significance.
Twice-daily fractionation was the most important treatment-related variable in this patient population.
确定治疗技术的改进以及每日两次分割放疗的常规使用是否影响下咽和/或口咽壁癌的局部控制可能性。
1964年10月至1990年7月期间，99例患有侵袭性、未经治疗的咽壁T1 - T4鳞状细胞癌患者在佛罗里达大学接受了以治愈为目的的连续疗程外照射放疗。所有患者均进行了至少2年的随访。
每日一次分割放疗与每日两次分割放疗患者的2年局部控制率分别为：T1期，均为100%；T2期，67% 对92%；T3期，43% 对80%；T4期，17% 对50%。采用我们以前的技术（当野从脊髓移开时，后边界置于椎体中部）与当前改进技术（后边界置于椎体后缘）治疗的患者的2年局部控制率分别为：T1期，均为100%；T2期，57% 对100%；T3期，46% 对73%；T4期，29% 对75%。对T分期、分割放疗方案、原发部位（口咽与下咽）、治疗技术以及咽壁外侧与后壁位置等参数进行多因素分析，以局部控制为终点。T分期（p = .003）、分割放疗方案（p = .001）和原发部位（p = .028）具有独立的预后意义。
在该患者群体中，每日两次分割放疗是与治疗相关的最重要变量。
