Antonello M, Polico R, Busetto M, Cazzato G, Zennaro B, Piccolo L, Bötner F, Pizzi G
Unità Operativa di Radioterapia Oncologica, Azienda ULSS 12-Veneziana, Presidio Ospedaliero Umberto I, Mestre.
Radiol Med. 1998 Sep;96(3):248-55.
We report our personal experience with the treatment of tonsillar cancers at the Otorhinolaryngology-Radiotherapy Department of Umberto I Hospital, Mestre, Italy. The results were analyzed by tumor site and stage, lymph node involvement, treatment type and patient age.
January, 1987, through December, 1995, we treated a hundred and 25 patients with carcinoma of the tonsil and tonsillar region. Most patients were men (M:F = 4:1), with a mean age of 61.9 years (range: 38-87). The lesions were staged at physical examination, chest radiography, bone scintigraphy. US of the liver and neck, CT and/or MRI of the tonsillar region and neck. Eleven patients were in stage I (8.8%), 26 in stage II (20.8%), 31 in stage III (24.8%) and 57 in stage IV (45.6%). Forty-one patients were submitted to tonsillectomy and more/less massive neck dissection: surgery was not radical-in 14 of them. All patients received gamma-photon radiotherapy with a cobalt unit: the minimum dose was 50 Gy after radical surgery and 60 Gy for exclusive irradiation and after nonradical surgery. The hemiblock field technique was always used with the conventional fractionation (2 Gy/day. 1 fraction/day, 5 fractions/week); the treatment was planned with the Theraplan V05-B method on CT scans. When the tolerance dose was reached, the spinal cord was shielded and the dose compensated with 9 MeV electrons. The treatment was discontinued only when needed, and never for more than 7-10 days.
The overall 5-year survival and the 5-year disease-free survival rates were 28% and 45%, respectively; the overall 5-year cause-specific survival rate was 39%. Disease-free survival was 81% in stage I, 52.7% in stage II, 44.2% in stage III and 35.8% in stage IV (p = .005). The 5-year disease-free survival for the patients receiving surgery and irradiation was 62.1%, versus 38.3% for irradiation alone; the rate was 37.6% when neck nodes were involved (N+). One hundred and two patients achieved complete remission (CR), while the other 23 had partial remission (PR). Twenty-eight CR patients recurred; the most common cause of death was failure in primary tumor local control. There were no complications during or after treatment. Secondary lesions were found in 13 patients (10.1%).
Irradiation alone yields fairly good results in early tonsil carcinoma, while the surgery-irradiation combination should be preferred in large tumors. Better results are expected from kinetic and conformal irradiation techniques with 3D calculations on CT and MR images, which should permit to deliver high doses to strictly targeted areas and to reduce side-effects. Other improvements are expected from new combination therapies.
我们报告了意大利梅斯特雷翁贝托一世医院耳鼻喉头颈放疗科治疗扁桃体癌的个人经验。通过肿瘤部位和分期、淋巴结受累情况、治疗类型和患者年龄对结果进行了分析。
1987年1月至1995年12月，我们治疗了125例扁桃体及扁桃体区癌患者。大多数患者为男性（男：女 = 4：1），平均年龄61.9岁（范围：38 - 87岁）。通过体格检查、胸部X线摄影、骨闪烁显像、肝脏及颈部超声、扁桃体区及颈部CT和/或MRI对病变进行分期。11例患者为I期（8.8%），26例为II期（20.8%），31例为III期（24.8%），57例为IV期（45.6%）。41例患者接受了扁桃体切除术及或多或少的根治性颈清扫术：其中14例手术不彻底。所有患者均使用钴源进行伽马光子放疗：根治性手术后最小剂量为50 Gy，单纯放疗及非根治性手术后为60 Gy。始终采用半野技术进行常规分割（2 Gy/天，1次/天，5次/周）；治疗计划采用Theraplan V05 - B方法在CT扫描上进行。当达到耐受剂量时，对脊髓进行屏蔽，并用9 MeV电子补偿剂量。仅在必要时中断治疗，且中断时间从不超过7 - 10天。
总体5年生存率和5年无病生存率分别为28%和45%；总体5年特定病因生存率为39%。I期无病生存率为81%，II期为52.7%，III期为44.2%，IV期为35.8%（p = 0.005）。接受手术加放疗患者的5年无病生存率为62.1%，而单纯放疗患者为38.3%；当颈部淋巴结受累（N +）时，该率为37.6%。102例患者实现完全缓解（CR），另外23例部分缓解（PR）。28例CR患者复发；最常见的死亡原因是原发肿瘤局部控制失败。治疗期间及治疗后均无并发症。13例患者（10.1%）发现继发肿瘤。
单纯放疗在早期扁桃体癌中产生相当好的结果，而对于大肿瘤应首选手术加放疗联合治疗。预计采用基于CT和MR图像的三维计算的动态和适形放疗技术会取得更好的结果，这将允许向严格靶向区域给予高剂量并减少副作用。新的联合治疗有望带来其他改善。
