Matsuura K, Hirokawa Y, Fujita M, Akagi Y, Ito K
Department of Radiology, Hiroshima University School of Dentistry, Japan.
Int J Radiat Oncol Biol Phys. 1998 Feb 1;40(3):535-9. doi: 10.1016/s0360-3016(97)00811-0.
To evaluate the prognostic importance of T classification and maximum tumor thickness (MTT) on the treatment results of Stage I and II oral tongue cancer treated with interstitial brachytherapy.
Between January 1981 and December 1993, 173 cases were eligible for this retrospective analysis. Of 173 patients, 75 were classified as Stage I and 98 as Stage II: maximum tumor length ranged from 6 to 40 mm. MTT, which ranged from 2 to 38 mm, was measured with ultrasonography and/or palpation. Brachytherapy was performed with iridium hairpins or radium needles following external irradiation in 66 patients, or exclusively in 107 patients.
The 5-year local recurrence rates were Stage I, 7%; Stage II, 22%; MTT < 8 mm, 8%; and MTT > or = 8 mm, 28%. The 5-year regional recurrence rates were Stage I, 15%; Stage II, 29%; MTT < 8 mm, 18%; and MTT > or = 8 mm, 31%, respectively. The 5-year local recurrence rates of the patients with Stage I and MTT < 8 mm of the brachytherapy only group were significantly better than those of Stage II and MTT > or = 8 mm (5% and 6% vs. 16% and 24%). The 5-year regional recurrence rates of the patients with Stage I and MTT < 8 mm of the brachytherapy-only group were significantly better than those of Stage II and MTT > or = 8 mm (14% and 16% vs. 34% and 46%). There was no significant difference in the 5-year regional recurrence rates between the two groups of Stage I and Stage II, MTT < 8 mm. However, there was a significant difference in the 5-year regional recurrence rates between the two groups of MTT > or = 8 mm (p < 0.005).
For patients with Stage I and II oral tongue cancer, tumor thickness as well as T classification were prognostic for nodal metastasis and prognosis. Patients with MTT > or = 8 mm are more likely to fail in the neck region. These findings suggest that MTT should be considered along with T stage in determining strategies for Stage I and II oral tongue cancer.
评估T分类和最大肿瘤厚度（MTT）对采用组织间近距离放射治疗的Ⅰ期和Ⅱ期口腔舌癌治疗结果的预后重要性。
1981年1月至1993年12月期间，173例患者符合此项回顾性分析的条件。173例患者中，75例被分类为Ⅰ期，98例为Ⅱ期：最大肿瘤长度为6至40毫米。MTT范围为2至38毫米，通过超声检查和/或触诊测量。66例患者在体外照射后采用铱发夹或镭针进行近距离放射治疗，或107例患者仅采用近距离放射治疗。
5年局部复发率为：Ⅰ期7%；Ⅱ期22%；MTT<8毫米，8%；MTT≥8毫米，28%。5年区域复发率为：Ⅰ期15%；Ⅱ期29%；MTT<8毫米，18%；MTT≥8毫米，31%。仅采用近距离放射治疗组中Ⅰ期且MTT<8毫米患者的5年局部复发率明显优于Ⅱ期且MTT≥8毫米患者（5%和6%对16%和24%）。仅采用近距离放射治疗组中Ⅰ期且MTT<8毫米患者的5年区域复发率明显优于Ⅱ期且MTT≥8毫米患者（14%和16%对34%和46%）。Ⅰ期和Ⅱ期且MTT<8毫米的两组患者5年区域复发率无显著差异。然而，MTT≥8毫米的两组患者5年区域复发率有显著差异（p<0.005）。
对于Ⅰ期和Ⅱ期口腔舌癌患者，肿瘤厚度以及T分类对淋巴结转移和预后具有预后意义。MTT≥8毫米的患者颈部区域更易治疗失败。这些发现表明，在确定Ⅰ期和Ⅱ期口腔舌癌的治疗策略时，应将MTT与T分期一并考虑。
