Chao K S, Emami B, Akhileswaran R, Simpson J, Spector G, Sessions D
Radiation Oncology Center, Washington University School of Medicine, St. Louis, MO 63110, USA.
Int J Radiat Oncol Biol Phys. 1996 Dec 1;36(5):1039-43. doi: 10.1016/s0360-3016(96)00424-5.
In patients with T1,T2 oral tongue carcinoma treated with surgical resection, postoperative radiation therapy (RT) is required especially when surgical margins contain tumors. Irradiation techniques include external beam, interstitial implants, or a combination of the two modalities. We investigated whether positive surgical margin remains a poor prognostic factor after radiation therapy, and the contribution of interstitial implants to disease control.
Between 1972 and 1989, 55 patients were treated postoperatively at the Mallinckrodt Institute of Radiology for T1,T2 squamous cell carcinomas of the oral tongue. Surgeries included 26 wide excisions or excisional biopsies and 29 composite resections or hemiglossectomies. Thirty-nine patients received external radiation therapy alone and 16 patients had an interstitial implant (ISI) as part of the treatment. The minimum follow-up is 4 years.
At 2 and 5 years, the overall survivals for all patients were 82 and 68%. The disease-free survivals (DFS) were 82 and 70%, respectively. There was no significant difference in the pattern of failure and DFS when stratified by the status of surgical margins and the type of the surgical procedure. Local control was achieved in 15 of 18 patients when surgical margins were involved by tumor and in 29 of 37 patients without tumor involving margins (p > 0.05). Ten of 18 (56%) patients with tumor involving resection margins were treated with ISI, whereas only 3 of 33 (9%) of those with negative margins received ISI. Local control was achieved in 32 of 39 patients treated with external beam RT alone, and 13 of 16 patients who received interstitial implant (p > 0.05). Four patients treated with ISI developed persistent soft tissue ulceration and mandibular bone exposures.
Postoperative radiation therapy converted the ominous outcome of patients with tumor involving surgical margins. Patients with positive surgical margins were often selected to be treated with interstitial implants. We found that the local control was as good as in those with a more favorable pathology (negative margins) and treated with external RT alone. Further investigation is needed to optimize the implant treatment to minimize the complications.
对于接受手术切除治疗的T1、T2期口腔舌癌患者，尤其是手术切缘有肿瘤残留时，术后需要进行放射治疗（RT）。照射技术包括外照射、组织间插植，或两种方式联合应用。我们研究了手术切缘阳性在放射治疗后是否仍然是一个不良预后因素，以及组织间插植对疾病控制的作用。
1972年至1989年间，55例T1、T2期口腔舌鳞状细胞癌患者在马林克罗特放射研究所接受术后治疗。手术包括26例广泛切除或切除活检，以及29例联合切除或半舌切除术。39例患者仅接受外照射治疗，16例患者接受组织间插植（ISI）作为治疗的一部分。最短随访时间为4年。
在2年和5年时，所有患者的总生存率分别为82%和68%。无病生存率（DFS）分别为82%和70%。根据手术切缘状态和手术方式类型进行分层时，失败模式和DFS没有显著差异。当手术切缘有肿瘤累及，18例患者中有15例实现了局部控制；手术切缘无肿瘤累及，37例患者中有29例实现了局部控制（p>0.05）。18例手术切缘有肿瘤累及的患者中有10例（56%）接受了ISI治疗，而切缘阴性的33例患者中只有3例（9%）接受了ISI治疗。仅接受外照射治疗的39例患者中有32例实现了局部控制，接受组织间插植的16例患者中有13例实现了局部控制（p>0.05）。4例接受ISI治疗的患者出现了持续性软组织溃疡和下颌骨暴露。
术后放射治疗改变了手术切缘有肿瘤累及患者的不良预后。手术切缘阳性的患者常被选择接受组织间插植治疗。我们发现，局部控制与手术切缘病理情况更有利（阴性切缘）且仅接受外照射治疗的患者一样好。需要进一步研究以优化插植治疗，将并发症降至最低。
