Verschuur H P, Keus R B, Hilgers F J, Balm A J, Gregor R T
Department of Otolaryngology, The Netherlands Cancer Institute, Amsterdam.
Head Neck. 1996 May-Jun;18(3):277-82. doi: 10.1002/(SICI)1097-0347(199605/06)18:3<277::AID-HED10>3.0.CO;2-8.
When patients are initially seen with a small primary tumor and regional metastases, the question arises whether the primary can be managed by definitive radiotherapy while treating the neck with surgery and postoperative radiation. The advantage of this is least disturbance of the primary site, while still achieving maximal control of the neck disease.
A retrospective review was conducted over an 8-year period; of the 619 patients seen during this time, 15 were judged suitable for this approach. Small primaries were defined as T1 or T2 lesions or superficial spreading T3 tumors. Extensive neck disease was defined as at least 3 cm in size.
There were no regional recurrences and only 3 local recurrences, 2 of which were successfully salvaged. Four patients died of distant metastases. The arguments for and against this unusual approach are discussed.
It is concluded that, in patients conforming to our criteria, this is a sound oncologic approach.
当患者最初被诊断为原发性小肿瘤并伴有区域转移时，就会出现这样一个问题：在对颈部进行手术和术后放疗的同时，原发性肿瘤能否通过根治性放疗来处理。这样做的优点是对原发部位的干扰最小，同时仍能最大程度地控制颈部疾病。
进行了一项为期8年的回顾性研究；在此期间诊治的619例患者中，有15例被判定适合采用这种方法。小原发性肿瘤定义为T1或T2病变或浅表扩散性T3肿瘤。广泛性颈部疾病定义为大小至少3厘米。
无区域复发，仅3例局部复发，其中2例成功挽救。4例患者死于远处转移。讨论了支持和反对这种不寻常方法的论据。
得出的结论是，对于符合我们标准的患者，这是一种合理的肿瘤学方法。
