Schultz C J, Campbell B H, Freije J E, Brook B J, McAuliffe T L
Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee 53226, USA.
Eur J Cancer B Oral Oncol. 1995 Sep;31B(5):310-4. doi: 10.1016/0964-1955(95)00042-9.
Laryngeal abnormalities following definitive irradiation for carcinoma of the larynx are common. The objective of this study was to identify risk factors for persistent cancer in such patients who were found to have abnormal larynges following definitive irradiation. A retrospective evaluation of 185 consecutive patients undergoing primary irradiation for a glottic or supraglottic laryngeal squamous carcinoma treated between 1976 and 1990 at the Affiliated Hospitals of the Medical College of Wisconsin was performed. From chart review, data concerning site, stage, intent of treatment, smoking history, treatment dose, fraction size, failure patterns, and outcome were obtained. In addition, worrisome signs and symptoms including ulceration, dysphasia, odynophagia, airway distress, aphonia, blood, pain, oedema, aspiration, and pneumonia were recorded. Univariate association with failure and a persistently abnormal laryngeal examination was assessed using the Mantel-Haenszel test. The odds ratio was used to estimate relative risk associated with dichotomous risk factors. Disease-free and overall survival were estimated using Kaplan-Meier methodology. The log rank test was used to compare survival as defined by the levels of various risk factors. Two-year disease-free survival was 83% (T1 = 93%, T2 = 72%, T3/T4 = 66%). Primary failure was associated with the presence of an abnormal examination (P = 0.001), tracheotomy (P = 0.001), symptom index (P = 0.002), aphonia (P = 0.003), advanced T stage (P = 0.03), and lower total dose (P = 0.03). Of 151 patients who survived 6 months disease-free with an intact larynx, an abnormal examination was seen in those with advanced T stage (P = 0.002), supraglottic primary (P = 0.003), symptom index (P = 0.008), eventual failure at the primary site (P = 0.008), continued smoking (P = 0.01), and higher total dose (P = 0.01). The symptom index (total signs and symptoms of airway distress, aphonia, ulceration, pain, oedema, dysphagia, blood production, aspiration, pneumonia, and odynophagia) was correlated with primary failure and continued smoking. Of 37 patients with continually normal examinations, only 1 (3%) failed at the primary site. Of 102 who survived 6 months but with an abnormal examination, 22 (22%) eventually developed a primary failure. Persistently abnormal larynges are common after radiation therapy, yet not all harbour cancer. Risk factors for persistent cancer include stage, airway, total dose, and symptom index. Patients whose larynges return to normal after radiation rarely fail at the primary site.
喉癌根治性放疗后出现喉部异常很常见。本研究的目的是确定在根治性放疗后喉部发现异常的此类患者中持续性癌症的危险因素。对1976年至1990年期间在威斯康星医学院附属医院接受声门或声门上喉鳞状细胞癌初次放疗的185例连续患者进行了回顾性评估。通过病历审查，获取了有关部位、分期、治疗意图、吸烟史、治疗剂量、分次剂量、失败模式和结局的数据。此外，记录了令人担忧的体征和症状，包括溃疡、吞咽困难、吞咽痛、气道窘迫、失音、咯血、疼痛、水肿、误吸和肺炎。使用Mantel-Haenszel检验评估与失败及喉部检查持续异常的单因素关联。比值比用于估计与二分危险因素相关的相对风险。采用Kaplan-Meier方法估计无病生存期和总生存期。对数秩检验用于比较由各种危险因素水平定义的生存率。两年无病生存率为83%（T1 = 93%，T2 = 72%，T3/T4 = 66%）。原发失败与检查异常（P = 0.001）、气管切开（P = 0.001）、症状指数（P = 0.002）、失音（P = 0.003）、晚期T分期（P = 0.03）和较低的总剂量（P = 0.03）相关。在151例喉部完整且无病生存6个月的患者中，晚期T分期（P = 0.002）、声门上原发（P = 0.003）、症状指数（P = 0.008）、原发部位最终失败（P = 0.008）、持续吸烟（P = 0.01）和较高的总剂量（P = 0.01）的患者出现检查异常。症状指数（气道窘迫、失音、溃疡、疼痛、水肿、吞咽困难、咯血、误吸、肺炎和吞咽痛的总体征和症状）与原发失败和持续吸烟相关。在37例检查持续正常的患者中，仅1例（3%）原发部位失败。在102例生存6个月但检查异常的患者中，22例（22%）最终出现原发失败。放疗后喉部持续异常很常见，但并非所有都有癌症。持续性癌症的危险因素包括分期、气道、总剂量和症状指数。放疗后喉部恢复正常的患者原发部位很少失败。
