Pernot M, Verhaeghe J L, Guillemin F, Carolus J M, Hoffstetter S, Peiffert D
Centre Alexis-Vautrin, centre régional de lutte contre le cancer, Vandoeuvre-les-Nancy, France.
Bull Cancer Radiother. 1995;82(3):311-7.
The study includes 346 carcinomas of the oral cavity (244 mobile tongues and 102 floors of mouth) treated by brachytherapy alone at primary tumor. We noted 199 T1, 131 T2, 14 T3 and 2 TxNx. Among T1, 36 patients had a neck dissection as well as 73 T2. Brachytherapy was performed according to the Paris system. In 59 cases, the curage on the lesion side was a radical neck dissection, in 14 cases a functional neck dissection and in 45 cases a submaxillary and submental dissection. A combined controlateral neck dissection was performed in 20 cases. A complementary irradiation of the node areas was given in 28 cases.
for T1, the local control (LC) is 96%, the locoregional control (LRC) 83%, the specific survival (SS) 88%, and the overall survival (OS) 73%. For T2, LC 85%, LRC 70%, SS 75%, OS 52%. For T3, LC 64%, LRC 44%, SS 25%, OS 18%. The difference is very significant between T1 T2 T3 (p < 0.006) for results concerning N0, it is not significant between the N1 in each category, but their number is too low to reach a degree of significancy. In the 36 neck dissection specimens of T1, we found only in 7 cases positive nodes and in the 73 specimens of T2, 24 cases of positive nodes. A detailed study is reported. Tumoral, node or both recurrences are summarized (see table IV). Node recurrences are more frequent in patients without neck dissection than in those with neck dissection for T1, T2, N0, but this is significant only for LRC, SS and OS between patients with negative nodes on neck dissection and those with positive nodes (p < 0.0001). No significant difference was found between OS and SS for patients T1, T2, N0 with positive systematic neck dissection and those with a neck dissection differed until the node recurrence. Among T1, T2, T3, we noted more metastases in patients who presented a recurrence than in others. In conclusion, for patients treated by brachytherapy alone to the primary lesion, it seems desirable to perform a systematic neck dissection if there are adenopathies on initial examination. The dissection can be delayed for small tumors T1 N0 and low T2 N0 if the patients are followed-up regularly. However, a systematic dissection must be advised for high T2 N0 and T3 N0 given the frequency of the node involvement and the risk of metastases.
该研究纳入了346例口腔癌患者（244例舌活动部癌和102例口底癌），原发肿瘤仅接受近距离放射治疗。我们记录到199例T1期、131例T2期、14例T3期和2例TxNx期患者。在T1期患者中，36例行颈部清扫术，T2期患者中有73例行颈部清扫术。近距离放射治疗按照巴黎系统进行。59例患者在病变侧行根治性颈部清扫术，14例患者行功能性颈部清扫术，45例患者行颌下和颏下清扫术。20例患者行对侧联合颈部清扫术。28例患者接受了淋巴结区域的补充照射。
对于T1期患者，局部控制率（LC）为96%，区域控制率（LRC）为83%，特异性生存率（SS）为88%，总生存率（OS）为73%。对于T2期患者，LC为85%，LRC为70%，SS为75%，OS为52%。对于T3期患者，LC为64%，LRC为44%，SS为25%，OS为18%。T1、T2、T3期之间的差异非常显著（p < 0.006）。对于N0期结果，各分类中N1期之间差异不显著，但由于数量过少未达到显著程度。在T1期的36例颈部清扫标本中，仅7例发现阳性淋巴结，在T2期的73例标本中，24例发现阳性淋巴结。报告了详细研究情况。总结了肿瘤、淋巴结或两者的复发情况（见表IV）。对于T1、T2、N0期患者，未行颈部清扫术的患者淋巴结复发比行颈部清扫术的患者更常见，但仅颈部清扫术后淋巴结阴性患者与阳性患者之间的LRC、SS和OS差异有统计学意义（p < 0.0001）。对于T1、T2、N0期行系统性颈部清扫术阳性患者与行颈部清扫术直至淋巴结复发患者之间，OS和SS未发现显著差异。在T1、T2、T3期患者中，我们注意到出现复发的患者比其他患者有更多转移。总之，对于仅对原发灶行近距离放射治疗的患者，如果初始检查发现有淋巴结肿大，似乎有必要行系统性颈部清扫术。对于T1 N0期小肿瘤和低T2 N0期患者，如果定期随访，清扫术可以延迟。然而，鉴于淋巴结受累频率和转移风险，对于高T2 N0期和T3 N0期患者必须建议行系统性清扫术。
