Dixit S, Vyas R K, Toparani R B, Baboo H A, Patel D D
Department of Radiation Oncology, The Gujarat Cancer and Research Institute, Ahmedabad, India.
Ann Surg Oncol. 1998 Sep;5(6):502-10. doi: 10.1007/BF02303642.
The efficacy of postoperative radiotherapy for squamous cell carcinoma of the buccal mucosa was evaluated.
One hundred seventy-six patients treated between 1989 and 1993 were analyzed. One hundred fifteen patients were treated with surgery alone (Group 1), and 61 patients were treated with a combination of surgery and postoperative radiotherapy (Group 2).
Actuarial 3-year locoregional control in Groups 1 and 2 was 11% and 48% for patients with stage III + IV cancer (P = .001) and 71% and 75% for patients with stage I + II cancer (P = .74), respectively. On multivariate analysis for locoregional failure, surgical margin, bone invasion, high grade, and node involvement were significant factors in Group 1, whereas in Group 2 only tumor thickness was a significant factor. For local failure, margin, bone invasion, and stage in Group 1 and tumor thickness in Group 2 appeared as significant factors. For nodal failure, clinical nodal (cl N0 vs. N+) stage and grade in Group 1 and pathologic nodal stage (pN0 + 1 vs. pN2) in Group 2 were observed as significant factors. On subset analysis, postoperative radiotherapy was observed to have a significant advantage for surgical margins of 2 mm or less in both early pT (T1 + T2) (P = .019) and late pT (T3 + T4) (P = .016) stages. The local failure rate was higher if the time between surgery and radiotherapy was greater than 30 days.
Postoperative radiotherapy was effective in decreasing locoregional failure in patients with close surgical margins, tumor thicker than 10 mm, high-grade tumors, positive node, and bone invasion. The effect of interval between surgery and postoperative radiotherapy on local failure was margin-dependent.
评估了术后放疗对颊黏膜鳞状细胞癌的疗效。
分析了1989年至1993年间接受治疗的176例患者。115例患者仅接受手术治疗（第1组），61例患者接受手术联合术后放疗（第2组）。
III + IV期癌症患者中，第1组和第2组的3年精算局部区域控制率分别为11%和48%（P = 0.001）；I + II期癌症患者中，该控制率分别为71%和75%（P = 0.74）。在局部区域失败的多因素分析中，手术切缘、骨侵犯、高分级和淋巴结受累是第1组的显著因素，而在第2组中只有肿瘤厚度是显著因素。对于局部失败，第1组的切缘、骨侵犯和分期以及第2组的肿瘤厚度是显著因素。对于淋巴结失败，第1组的临床淋巴结（cl N0与N+）分期和分级以及第2组的病理淋巴结分期（pN0 + 1与pN2）是显著因素。在亚组分析中，观察到术后放疗在早期pT（T1 + T2）（P = 0.019）和晚期pT（T3 + T4）（P = （此处原文有误，推测为0.016））阶段对于2mm或更小的手术切缘均具有显著优势。如果手术与放疗之间的时间大于30天，局部失败率会更高。
术后放疗对于手术切缘接近、肿瘤厚度超过10mm、高分级肿瘤、淋巴结阳性和骨侵犯的患者，在降低局部区域失败方面有效。手术与术后放疗之间的间隔时间对局部失败的影响取决于切缘情况。
