SINGLE AND MULTIPLE TREATMENT MODALITIES IN TREATMENT OF BUCCAL CANCER

放射線暨合併療法對口腔黏膜癌治療之評估

趙坤山(Kurt-San Chao) ； 林芳仁(Fang-Ien Lin)

《中華放射線醫學雜誌》 13卷2期 (1988/06) Pp. 193-200

摘要

This article concerns our experience with 55 buccal cancer patients seen and treated at CGMH from February 1979 through April 1985. Fifty-two patients were male. 3 female. Nine patients underwent surgery alone (S), 15 receive surgery plus post-operative radiation therapy (S + RT), and 4 were treated with pre-operative radiation therapy plus surgery (RT + S). Twenty-seven patients received just radiation therapy (RT). In treating early lesions (Stages I and II) surgery and RT fared equally well (P ＞0.05). However, no matter which treatment modality was used, the treatment outcome of advanced disease (Stage III and IV) was poor (0% to 36%). Multiple daily fractionation RT and combination of RT and chemotherapy showed a promising role in the improvement of local control and long term survival for patients suffering from advanced disease. The predominance of primary site failure points to the inadequacy of local treatment, i.e., either inadequate surgery or inadequate RT. Furthermore, the relatively high incidence of regional lymph node failure in RT alone group suggests that radical neck dissection should be considered whenever neck nodes are present or when dealing with bulky tumors.

關鍵字

radiation therapy ； time dose fractionation factor (TDF)

並列摘要

長庚醫院自民國六十八年至民國七十四年四月，共有口腔黏膜癌病患55名接受放射治療，手術治療及合併療法，其中有28例為T_1或T_2之腫瘤，其餘27例T_3，T_4之病例中74%合併有淋巴腺之轉移，放射治療及手術治療在早期口腔癌的控制上效果一樣好；雖然手術合併術後放射治療似乎對治療晚期口腔癌效果較好，但仍未能到達統計學上有意義之程度。對於使用放射治療來控制疾病的病例，我們可以發現劑量高於TDF=100的病例存活情形較好，而在接受手術及術後放射治療的病例中，存活情形則與劑量多寡無關。大部份治療失敗的情況，皆發生於腫瘤原發部位，而淋巴腺的再發則在接受單獨放射治療的病人較常見，所以對口腔癌合併淋巴腺轉移的病例，我們或可建議病人接受手術治療及術後放射治療。