Fein D A, Mendenhall W M, Parsons J T, Million R R
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville.
Int J Radiat Oncol Biol Phys. 1993 Mar 15;25(4):605-11. doi: 10.1016/0360-3016(93)90005-g.
To examine various parameters that might influence the probability of local control of T1-T2 glottic carcinoma treated with radiotherapy.
Two hundred forty-seven patients with invasive, previously untreated T1-T2 squamous cell carcinoma of the glottic larynx were treated with radiotherapy between May 1977 and December 1989. All patients had a minimum 2-year follow-up. To minimize treatment-related variables, only patients with T1 lesions treated once daily at 225 cGy per fraction and patients with T2 lesions treated once daily at 225 cGy per fraction or twice daily at 120 cGy per fraction were included. Surgical alternative, thickness of the neck at the posterior edge of the lateral fields, vocal cord mobility, anterior commissure involvement, gender, and T stage were evaluated in a multivariate analysis.
The 5-year local control rates, calculated by the product-limit method, were T1a, 95%; T1b, 96%; T2a, 87%; and T2b, 76%. The 5-year local control rate for patients with T2 lesions treated with once-daily fractionation was 81% compared with 91% for those who received twice-a-day radiotherapy. For the endpoint of local control with irradiation, the surgical alternative (p = .020) and cord mobility (p = .001) were of independent prognostic significance.
Of the variables analyzed, only vocal cord mobility and surgical alternative significantly influenced local control. Specifically, anterior commissure involvement and neck thickness did not affect local control.
研究可能影响放射治疗T1 - T2期声门癌局部控制概率的各种参数。
1977年5月至1989年12月期间，对247例浸润性、未经治疗的T1 - T2期声门鳞状细胞癌患者进行放射治疗。所有患者至少随访2年。为尽量减少与治疗相关的变量，仅纳入T1期病变患者，每日单次分割剂量为225 cGy，以及T2期病变患者，每日单次分割剂量为225 cGy或每日两次分割剂量为120 cGy。在多变量分析中评估了手术替代方案、侧野后缘处颈部厚度、声带活动度、前联合受累情况、性别和T分期。
采用乘积限界法计算的5年局部控制率为：T1a期95%；T1b期96%；T2a期87%；T2b期76%。每日单次分割治疗的T2期病变患者的5年局部控制率为81%，而每日两次分割放疗患者的为91%。对于放疗局部控制的终点，手术替代方案（p = 0.020）和声带活动度（p = 0.001）具有独立的预后意义。
在分析的变量中，仅声带活动度和手术替代方案对局部控制有显著影响。具体而言，前联合受累和颈部厚度不影响局部控制。
