Hicks W L, Kuriakose M A, Loree T R, Orner J B, Schwartz G, Mullins A, Donaldson C, Winston J M, Bakamjian V Y
Roswell Park Cancer Institute, Department of Head and Neck Surgery, Buffalo, New York 14263, USA.
Laryngoscope. 1998 Jul;108(7):1014-9. doi: 10.1097/00005537-199807000-00012.
To compare the efficacy and treatment outcomes in patients with tonsillar fossa cancer using surgery or radiation as a single modality therapy.
From 1971 to 1991 239 patients with oral pharyngeal cancer were treated at Roswell Park Cancer Institute. Of these patients 90 had tonsillar carcinoma. Seventy-six of these patients received either surgery (SA) (n = 56) or radiation therapy (RA) (n = 20) as single-modality therapy and are the subject of this review. All patients in the radiation arm of this review were surgical candidates who declined primary surgical therapy.
Sixty-three percent of the SA and 80% of the RA treatment groups presented with either stage III or stage IV disease (P < or = .05). Forty-seven percent of the SA group and 52% of the RA patients had clinically positive regional disease at initial presentation. There was a predictable pattern of nodal presentation, with level II the most frequently involved region. The rate of occult metastasis was 27% and was evenly distributed between T1 and T4 disease. The overall local control rate in the SA group was 75%, compared with 60% in the RA group (P value was not significant). The disease-specific survival (all stages) was 61% in the SA group and 37% in the RA group (P < or = .05). The disease-free survival for stage III and stage IV disease in the SA group was 47% and in the RA group 27% (P < or = .05). Survival measured against clinical response to radiation therapy, in complete responders (all stages) was 83%; by contrast there were no survivors past 24 months in the partial response group (P < or = .001).
The results from this study suggest that for early disease (stage I/II), surgery or radiation therapy as single-modality treatment is equally effective. For advanced disease radiation therapy is inferior to surgery as a single-modality treatment, as measured by ultimate survival and the local control of disease. There is, however, a subset of patients with advanced disease who respond to radiation therapy and whose survival is equivalent to our surgical cohort of patients.
比较采用手术或放疗作为单一治疗方式治疗扁桃体窝癌患者的疗效及治疗结果。
1971年至1991年期间，罗斯韦尔帕克癌症研究所对239例口咽癌患者进行了治疗。其中90例患有扁桃体癌。这些患者中有76例接受了手术（SA）（n = 56）或放疗（RA）（n = 20）作为单一治疗方式，是本综述的研究对象。本综述中接受放疗组的所有患者均为拒绝接受初次手术治疗的手术候选者。
SA治疗组的63%和RA治疗组的80%患者表现为III期或IV期疾病（P≤0.05）。SA组的47%和RA组的52%患者在初次就诊时临床区域疾病呈阳性。存在可预测的淋巴结转移模式，II区是最常受累区域。隐匿性转移率为27%，在T1和T4疾病之间分布均匀。SA组的总体局部控制率为75%，而RA组为60%（P值无统计学意义）。SA组的疾病特异性生存率（所有分期）为61%，RA组为37%（P≤0.05）。SA组III期和IV期疾病的无病生存率为47%，RA组为27%（P≤0.05）。根据对放疗的临床反应衡量的生存率，完全缓解者（所有分期）为83%；相比之下，部分缓解组24个月后无幸存者（P≤0.001）。
本研究结果表明，对于早期疾病（I/II期），手术或放疗作为单一治疗方式同样有效。对于晚期疾病，就最终生存率和疾病局部控制而言，放疗作为单一治疗方式不如手术。然而，有一部分晚期疾病患者对放疗有反应，其生存率与我们的手术患者队列相当。
