Perez C A, Patel M M, Chao K S, Simpson J R, Sessions D, Spector G J, Haughey B, Lockett M A
Radiation Oncology Center, Mallinckrodt Institute of Radiology, St. Louis, MO 63108, USA.
Int J Radiat Oncol Biol Phys. 1998 Dec 1;42(5):1077-84. doi: 10.1016/s0360-3016(98)00291-0.
To identify prognostic parameters and evaluate the therapeutic outcomes for patients with carcinoma of the tonsillar fossa treated with three treatment modalities.
The results of therapy are reported in 384 patients with histologically proven epidermoid carcinoma of the tonsillar fossa; 154 were treated with irradiation alone (55-70 Gy), 144 with preoperative radiation therapy (20-40 Gy), and 86 with postoperative irradiation (50-60 Gy). The operation in all but four patients in the last two groups consisted of an en bloc radical tonsillectomy with ipsilateral lymph node dissection.
Treatment modality and total irradiation doses had no impact on survival. Actuarial 10-year disease-free survival rates were 65% for patients with T1 tumors, 60% for T2, 60% for T3, and 30% for T4 disease. Patients with no cervical lymphadenopathy or with a small metastatic lymph node (N1) had better disease-free survival (60% and 70%, respectively) at 5 years than those with large or fixed lymph nodes (30%). Primary tumor recurrence (local, marginal) rates in the T1, T2, and T3 groups were 20-25% in patients treated with irradiation and surgery and 31% for those treated with irradiation alone (difference not statistically significant). In patients with T4 disease treated with surgery and postoperative irradiation, the local failure rate was 32% compared with 86% with low-dose preoperative irradiation and 47% with irradiation alone (p = 0.03). The overall recurrence rates in the neck were 10% for N0 patients, 25% for N1 and N2, and 35-40% for patients with N3 cervical lymph nodes, without significant differences among the various treatment groups. The incidence of contralateral neck recurrences was 8% with the various treatment modalities. On multivariate analysis the only significant factors for local tumor control and disease-free survival were T and N stage (p = 0.04-0.001). Fatal complications were noted in 7 of 144 (5%) patients treated with preoperative irradiation and surgery, 2 of 86 (2%) of those receiving postoperative irradiation, and 2 of 154 (1.3%) patients treated with radiation therapy alone. Other moderate or severe nonfatal sequelae were noted in 30% of the patients treated with preoperative irradiation and surgery, in 53% treated with postoperative irradiation, and in 19% receiving radiation therapy alone.
Primary tumor and neck node stage are the only significant prognostic factors influencing locoregional tumor control and disease-free survival. Treatment modality had no significant impact on outcome. Radiation therapy remains the treatment of choice for patients with stage T1-T2 carcinoma of the tonsillar fossa. In patients with T3-T4 tumors and good general condition, combination surgery and postoperative irradiation offers better tumor control than single-modality and preoperative irradiation procedures, but with greater morbidity.
确定预后参数并评估采用三种治疗方式治疗的扁桃体窝癌患者的治疗效果。
报告了384例经组织学证实为扁桃体窝表皮样癌患者的治疗结果；154例仅接受放疗（55 - 70 Gy），144例接受术前放疗（20 - 40 Gy），86例接受术后放疗（50 - 60 Gy）。除最后两组中的4例患者外，其余所有患者的手术均为整块根治性扁桃体切除术及同侧淋巴结清扫术。
治疗方式和总放疗剂量对生存率无影响。T1期肿瘤患者的10年无病生存率精算值为65%，T2期为60%，T3期为60%，T4期疾病为30%。无颈部淋巴结转移或有小转移淋巴结（N1）的患者5年无病生存率（分别为60%和70%）优于有大或固定淋巴结的患者（30%）。T1、T2和T3组中，接受放疗和手术治疗的患者原发肿瘤复发（局部、边缘）率为2０% - 25%，单纯放疗患者为31%（差异无统计学意义）。接受手术和术后放疗的T4期疾病患者局部失败率为32%，低剂量术前放疗患者为86%，单纯放疗患者为47%（p = 0.03）。颈部总体复发率在N0患者中为10%，N1和N2患者中为25%，N3颈部淋巴结患者中为35% - 40%，不同治疗组之间无显著差异。不同治疗方式下对侧颈部复发率均为8%。多因素分析显示，局部肿瘤控制和无病生存的唯一显著因素是T和N分期（p = 0.04 - 0.001）。144例接受术前放疗和手术治疗的患者中有7例（5%）出现致命并发症，86例接受术后放疗的患者中有2例（2%），154例单纯接受放疗的患者中有2例（1.3%）。30%接受术前放疗和手术治疗的患者、53%接受术后放疗的患者以及19%单纯接受放疗的患者出现其他中度或重度非致命后遗症。
原发肿瘤和颈部淋巴结分期是影响局部区域肿瘤控制和无病生存的唯一显著预后因素。治疗方式对治疗结果无显著影响。放疗仍是扁桃体窝T1 - T2期癌患者的首选治疗方法。对于T3 - T4期肿瘤且一般状况良好的患者，手术与术后放疗联合应用比单一治疗方式和术前放疗能更好地控制肿瘤，但并发症发生率更高。
