Le Q T, Fu K K, Kroll S, Ryu J K, Quivey J M, Meyler T S, Krieg R M, Phillips T L
Department of Radiation Oncology, University of California, San Francisco 94143, USA.
Int J Radiat Oncol Biol Phys. 1997 Aug 1;39(1):115-26. doi: 10.1016/s0360-3016(97)00284-8.
To evaluate the influence of fraction size, overall time, total dose, and other prognostic factors on local control of T1 and T2 glottic carcinomas.
Between 1956 and 1995, 398 consecutive patients with early glottic carcinoma (315 T1 and 83 T2) were treated with once-a-day definitive radiotherapy at the University of California, San Francisco, and associated institutions. Treatment was delivered 5 days per week. Minimum tumor dose ranged from 46.6 to 77.6 Gy (median: 63 Gy). The fraction size was < 1.8 Gy in 146; 1.8-1.99 Gy in 128; 2.0-2.24 Gy in 62, and > or = 2.25 Gy in 62 patients. Overall time ranged from 34 to 75 days (median: 50 days). The majority of patients treated with a fraction size of 2.25 Gy completed therapy within 43 days. Median follow-up of all alive patients was 116 months (range 3-436 months).
Five-year local control was 85% for T1 and 70% for T2 glottic carcinomas (p = 0.0004). For T1 lesions, within the dose and time range evaluated, there was no apparent relationship between fraction size, overall time, total dose, and local control on multivariate analysis. Treatment era was the only significant prognostic factor (p = 0.02), and anterior commissure (AC) involvement was of borderline significance (p = 0.056). Five-year local control was 77% for patients treated between 1956-1970, 89% for between 1971-1980, and 91% for between 1981-1995; 80% for patients with AC involvement and 88% for those without. For T2 lesions, prognostic factors for local control on multivariate analysis were: overall time (p = 0.003), fraction size (p = 0.003), total dose (p = 0.01), impaired vocal cord mobility (p = 0.02), and subglottic extension (p = 0.04). Five-year local control was 100% for T2 lesions treated with overall time < or = 43 days vs. 84% for overall time > 43 days; 100% for fraction size > or = 2.25 Gy vs. 44% for fraction size < 1.8 Gy; 78% for total dose > 65 Gy vs. 60% for total dose < or = 65 Gy; 79% for normal cord mobility vs. 45% for impaired cord mobility, and 58% for lesions with subglottic extension vs. 77% for those without. The severe complication rate for the entire group was low: 1.8%.
Total dose, fraction size, and overall time were significant factors for local control of T2 but not T1 glottic carcinomas. Anterior commissure involvement was associated with decreased local control for T1 but not T2 lesions. For T1 lesions, local control improved over the treatment era. For T2 lesions, local control decreased with impaired cord mobility and subglottic extension.
评估分次剂量、总治疗时间、总剂量及其他预后因素对T1和T2声门癌局部控制的影响。
1956年至1995年间，加利福尼亚大学旧金山分校及相关机构对398例连续性早期声门癌患者（315例T1期和83例T2期）进行了每日一次的根治性放疗。每周治疗5天。最小肿瘤剂量范围为46.6至77.6 Gy（中位数：63 Gy）。146例患者的分次剂量<1.8 Gy；128例为1.8 - 1.99 Gy；62例为2.0 - 2.24 Gy；62例患者的分次剂量≥2.25 Gy。总治疗时间范围为34至75天（中位数：50天）。大多数分次剂量为2.25 Gy的患者在43天内完成治疗。所有存活患者的中位随访时间为116个月（范围3 - 436个月）。
T1声门癌的5年局部控制率为85%，T2声门癌为70%（p = 0.0004）。对于T1病变，在评估的剂量和时间范围内，多因素分析显示分次剂量、总治疗时间、总剂量与局部控制之间无明显关系。治疗年代是唯一显著的预后因素（p = 0.02），前联合受累具有临界显著性（p = 0.056）。1956 - 1970年间接受治疗的患者5年局部控制率为77%，1971 - 1980年间为89%，1981 - 1995年间为91%；前联合受累患者为80%，未受累患者为88%。对于T2病变，多因素分析中局部控制的预后因素为：总治疗时间（p = 0.003）、分次剂量（p = 0.003）、总剂量（p = 0.01）、声带活动受限（p = 0.02）和声门下扩展（p = 0.04）。总治疗时间≤43天的T2病变5年局部控制率为100%，总治疗时间>43天的为84%；分次剂量≥2.25 Gy的为100%，分次剂量<1.8 Gy的为44%；总剂量>65 Gy的为78%，总剂量≤65 Gy的为60%；声带活动正常的为79%，声带活动受限的为45%，有声门下扩展的病变为58%，无扩展的为77%。整个组的严重并发症发生率较低：1.8%。
总剂量、分次剂量和总治疗时间是T2声门癌局部控制的重要因素，但不是T1声门癌的重要因素。前联合受累与T1病变局部控制率降低相关，但与T2病变无关。对于T1病变，局部控制在治疗年代有所改善。对于T2病变，局部控制率随声带活动受限和声门下扩展而降低。
