Lee W R, Mancuso A A, Saleh E M, Mendenhall W M, Parsons J T, Million R R
Dept. of Radiation Oncology, University of Florida College of Medicine, Gainesville.
Int J Radiat Oncol Biol Phys. 1993 Mar 15;25(4):683-7. doi: 10.1016/0360-3016(93)90016-o.
To determine if pretreatment computed tomography findings can predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone.
Twenty-nine patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated for cure with radiotherapy alone; all had a minimum 2-year follow-up. High-quality pretreatment computed tomography scans were retrospectively reviewed by a single head and neck radiologist for tumor involvement of various anatomic subsites within the larynx, and total tumor volumes were calculated for 18 of the most recent patients using a computer digitizer. A tumor score was calculated and assigned to each primary lesion depending on the extent of laryngeal spread.
A significant decrease in the local control rate was observed for cancers involving the face of the arytenoid (11 of 20 [55%] vs. 9 of 9 [100%]; p = .02), or the paraglottic space at the false vocal cord level (7 of 16 [44%] vs. 13 of 13 [100%]; p not equal to < .01). Tumors assigned a high tumor score (6, 7, or 8) had a significantly decreased rate of local control with radiation therapy when compared with tumors assigned a low tumor score (< or = 5): 1 of 7 (14%) vs. 19 of 22 (86%) (p = .01). Total tumor volume also significantly correlated with the rate of tumor control. For tumors measuring 3.5 cm3 or less, local control was achieved in 11 of 12 patients (92%), whereas for tumors greater than 3.5 cm3, local control was achieved in 2 of 6 patients (33%) (p = .02).
Pretreatment computed tomography scans can contribute significantly to the treatment decision for patients with T3 glottic carcinoma and can define a subset of patients with an excellent chance of being cured with preservation of a functional larynx after treatment with radiotherapy alone.
确定放疗前计算机断层扫描（CT）结果能否预测单纯放疗治疗的声门型喉T3期鳞状细胞癌的局部控制情况。
29例未经治疗的声门型喉T3期鳞状细胞癌患者接受单纯放疗以治愈疾病；所有患者均进行了至少2年的随访。由一名头颈放射科医生对高质量的放疗前CT扫描进行回顾性分析，以评估喉内各个解剖亚部位的肿瘤累及情况，并使用计算机数字化仪计算了最近18例患者的肿瘤总体积。根据喉内扩散范围计算肿瘤评分，并将其分配到每个原发灶。
观察到杓状软骨面部受累的癌症局部控制率显著降低（20例中的11例[55%]对9例中的9例[100%]；p = 0.02），或假声带水平的声门旁间隙受累的癌症局部控制率显著降低（16例中的7例[44%]对13例中的13例[100%]；p < 0.01）。与低肿瘤评分（≤5）的肿瘤相比，高肿瘤评分（6、7或8）的肿瘤放疗后的局部控制率显著降低：7例中的1例（14%）对22例中的19例（86%）（p = 0.01）。肿瘤总体积也与肿瘤控制率显著相关。对于体积为3.5 cm³或更小的肿瘤，12例患者中有11例（92%）实现了局部控制，而对于体积大于3.5 cm³的肿瘤，6例患者中有2例（3%）实现了局部控制（p = 0.02）。
放疗前CT扫描可为声门型喉T3期癌患者的治疗决策提供重要参考，并可确定一部分患者，这些患者在单纯放疗后有极好的机会在保留喉功能的情况下治愈。
