Hicks W L, Loree T R, Garcia R I, Maamoun S, Marshall D, Orner J B, Bakamjian V Y, Shedd D P
Division of Head and Neck Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Head Neck. 1997 Aug;19(5):400-5. doi: 10.1002/(sici)1097-0347(199708)19:5<400::aid-hed6>3.0.co;2-3.
This study retrospectively examines our treatment choices and outcomes with patients diagnosed with squamous cell cancer of the floor of mouth. Because of our division's past strong surgical bias in the treatment of this disease, we have assessed the results of a patient population treated largely by surgical extirpation. This clinical information has been used to draw conclusions and formulate treatment paradigms for patients with floor of mouth cancer.
Four hundred fifty patients with the diagnosis of squamous cell carcinoma of the oral cavity received their primary treatment at Roswell Park Cancer Center (RPCI) from 1971 to 1991. Ninety-nine had disease originating in the floor of mouth and are the basis of this retrospective review.
Forty-three percent of the patients had early-stage disease (stage I or II). Five-year survival for stages I through IV was 95%, 86%, 82%, and 52%, respectively. The incidence of occult cervical metastases for clinical stage I patients was 21%. For clinical stage II patients, the incidence was 62%. Local control of patients treated with surgery alone was 81%. The regional control rate for these patients was 71%. In patients where negative margins were achieved (> or = 5 mm), the local recurrence rate was 13%, regardless of T stage. Eleven percent of the patients underwent a course of postoperative radiotherapy; all had stage IV disease. When compared with advanced-stage patients undergoing surgery alone, there was a significantly improved regional control rate and a trend toward enhanced survival in the patients receiving adjuvant radiotherapy.
There is a significantly high incidence of occult metastatic disease (21%) for T1 lesions or greater in floor of mouth cancer to warrant elective treatment of regional lymphatics. In patients treated with surgery alone with negative margins, the local control rate was 90% versus 62% when the margins were close or positive. Adjunctive radiotherapy showed a statistically significant (p = .005) increased regional control in patients with stage IV disease. Adjunctive radiotherapy is warranted for increased regional control of disease; good local control can be achieved in floor of mouth cancer with surgery alone when negative margins are obtained.
本研究回顾性分析了我们对诊断为口腔底鳞状细胞癌患者的治疗选择及结果。由于我们科室过去在该疾病治疗上存在强烈的手术倾向，我们评估了主要通过手术切除治疗的患者群体的结果。这些临床信息已用于得出结论并为口腔底癌患者制定治疗模式。
1971年至1991年期间，450例诊断为口腔鳞状细胞癌的患者在罗斯韦尔公园癌症中心（RPCI）接受了初始治疗。其中99例疾病起源于口腔底，是本回顾性研究的基础。
43%的患者为早期疾病（I期或II期）。I期至IV期患者的5年生存率分别为95%、86%、82%和52%。临床I期患者隐匿性颈部转移的发生率为21%。临床II期患者的发生率为62%。单纯手术治疗患者的局部控制率为81%。这些患者的区域控制率为71%。在切缘阴性（≥5毫米）的患者中，无论T分期如何，局部复发率为13%。11%的患者接受了术后放疗疗程；均为IV期疾病。与单纯接受手术的晚期患者相比，接受辅助放疗的患者区域控制率显著提高，且有生存改善的趋势。
口腔底癌中T1期及以上病变隐匿性转移疾病的发生率显著较高（21%），因此有必要对区域淋巴结进行选择性治疗。在切缘阴性的单纯手术治疗患者中，局部控制率为90%，而切缘接近或阳性时为62%。辅助放疗在IV期疾病患者中显示出具有统计学意义（p = 0.005）的区域控制增加。辅助放疗对于提高疾病的区域控制是必要的；当获得阴性切缘时，单纯手术即可在口腔底癌中实现良好的局部控制。
