Zelefsky M J, Harrison L B, Fass D E, Armstrong J G, Shah J P, Strong E W
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Int J Radiat Oncol Biol Phys. 1993 Jan;25(1):17-21. doi: 10.1016/0360-3016(93)90139-m.
The presence of a positive or close margin after resection of a squamous cancer of the head and neck is associated with a significant risk of local recurrence. To determine the efficacy of postoperative radiation therapy for patients with advanced oral cavity and oropharyngeal cancers with inadequate margins of resection, the present retrospective analysis was undertaken.
One hundred and two patients were treated with surgery and postoperative radiation therapy for advanced squamous cell carcinomas of the oral cavity and oropharynx. The anatomic subsites treated include oral tongue (n = 29), floor of mouth (n = 22), base of tongue (n = 31) and tonsillar fossa (n = 20). Twenty-five patients (25%) had positive margins, 41 patients (40%) had close margins (< or = 0.5 cm from the surgical margin) and 36 (35%) had negative margins. The median radiation dose was 6000 cGy.
With a median follow-up of 7 years, the actuarial control rate for patients with positive, close and negative margins was 79%, 71%, and 79%, respectively. When postoperative doses of > or = 60 Gy were delivered to patients with positive/close margins (excluding patients with oral tongue lesions), the 7-year actuarial control was 92%. In similar patients receiving < 60 Gy, the actuarial control was 44% (p = 0.0007). Compared to other anatomic subsites, inferior control rates were obtained with oral tongue lesions. For this subsite, the control rates for positive, close, and negative margins were 50%, 62% and 69% respectively.
We conclude that excellent local control can be achieved with postoperative radiation therapy, despite the presence of inadequate margins of resection, when doses of > or = 60 Gy are used. Future strategies must be directed at further improving these results in patients with oral tongue lesions.
头颈部鳞状细胞癌切除术后切缘阳性或接近切缘与局部复发的显著风险相关。为了确定术后放疗对切除切缘不充分的晚期口腔癌和口咽癌患者的疗效，进行了本回顾性分析。
102例患者接受了手术及术后放疗，治疗晚期口腔和口咽鳞状细胞癌。治疗的解剖亚部位包括舌体（n = 29）、口底（n = 22）、舌根（n = 31）和扁桃体窝（n = 20）。25例患者（25%）切缘阳性，41例患者（40%）切缘接近（距手术切缘≤0.5 cm），36例患者（35%）切缘阴性。中位放疗剂量为6000 cGy。
中位随访7年，切缘阳性、接近和阴性患者的精算控制率分别为79%、71%和79%。当对切缘阳性/接近的患者（不包括舌体病变患者）给予术后剂量≥60 Gy时，7年精算控制率为92%。在接受<60 Gy的类似患者中，精算控制率为44%（p = 0.0007）。与其他解剖亚部位相比，舌体病变患者的控制率较低。对于该亚部位，切缘阳性、接近和阴性的控制率分别为50%、62%和69%。
我们得出结论，当使用剂量≥60 Gy时，尽管切除切缘不充分，但术后放疗仍可实现良好的局部控制。未来的策略必须致力于进一步改善舌体病变患者的这些结果。
