Curative Radiotherapy for Vocal Cord Carcinoma

喉癌的放射治療

翁益強(Weng Yih-Chyang) ； 林進清(Jin-Ching Lin) ； 詹建勝(Jian-Sheng Jan)

《放射治療與腫瘤學》 2卷3期 (1995/09) Pp. 187-192

https://doi.org/10.6316/TRO/199502(3)187

摘要

放射治療對喉癌患者不僅有好的局部治療效果，尤其能良好保持患者的說話功能。從1983年2月到1992年12月，共有75位喉癌患者在台中榮總單獨接受放射治療，其中男性69位，女性6位，平均年齡64歲。
75位患者中，40位是原位腫瘤第1期，22位是原位腫瘤第2期，8位是原位腫瘤第3期，和5位是原位腫瘤第4期。另外75五位患者中有5位有頸部淋巴轉移，其中有一位是原位腫瘤第1期，一位原位是腫瘤第2期，一位是原位腫瘤第3期，二位是原位腫瘤第4期。
大部分患者放射治療是以每日200至220cGy，兩側對照，總劑量爲6,000至6,600cGy。有8位患者是以每日放射治療兩次，每次150至170cGy，兩側對照，總劑量5,800至7,400cGy。以及另一位患者是以兩段式放射治療，每日是以300cGy，兩側對照，每一階段照射10次，中間休患兩週，總劑量共為6,000cGy。
幾乎所有患者都能很快從放射治療急性反應中恢復，除了一位患者治療後兩個月內發生嚴重聲帶浮腫，及另兩位患者在治療最後兩週因肺癌過逝。
經放射治療後，發聲功能保留率爲96%。原位腫瘤第一期5年無病存活率為86%，第二期為80%,第三期為75%，而第四期患者都在18個月內過逝，其p值小於0.001。對於無淋巴轉移之患者5年無病存活率為82%，而有淋巴轉移之患者都在30個月內過逝，其p值小於0.001。因此原位腫瘤第四期與有淋巴轉移之患者的預後十分差。另外針對性別和年齡區分來探討患者5年無病存活率，則無明顯差別。
5位接受每日放射治療兩次的早期患者，經治療後，目前追踪兩年以上，暫無病症，初期療效不錯，但需進一步觀察。

關鍵字

喉癌 ； 放射治療

並列摘要

Radiotherapy for vocal cord carcinoma plays an important role in controlling the primary tumors and regional lymph nodes and preserving the voice. From February 1983 to December 1992, 75 patients with vocal cord carcinoma were treated by curative radiotherapy alone at VGHTC. 69 patients were male and 6 patients were female. The median age was 64 years old.
There were 40 of 75 patients with Ti, 22 with T2, 8 with T3 and 5 with T4. 5 of 75 patients had positive lymph node metastases (1 of 5 patients with TI, 1 with T2, 1 with T3, and 2 with T4).
External beam radiotherapy was mostly delivered with bilateral opposing portals and a single daily fraction between 200cGy and 220cCy per day, up to a total dose between 6000cGy and 6600cGy. 8 patients were treated with bilateral opposing portals and hyperfractionation using 150cGy to 170cGy bid per day, up to a total dose between 5800cGy to 7400cGy. 1 patient was treated with bilateral opposing portals and split course technique of 300cGy per day with two weeks interval, up to 6000cGy.
Almost all patients recovered from acute reactions of radiotherapy soon except one patient with acute laryngeal edema in 2 months post radiotherapy and two patients with acute pneumonia due to cachexia in the last days of radiotherapy.
The vocal function preservation rate is about 96%. The 5-year disease- free survival rates in stage Ti, T2 and T3 were 86%, 80% and 75% respectively and T4 patients all died in 18 months. The P value is less than 0.001. The 5-year disease-free survival rate in stage N0 was 82% but N positive patients died in 30 months post radiotherapy. The P value is less than 0.001. Therefore T4 stage and N positive were obviously poorly prognostic factors. No significant differences of 5-year disease-free survival rates between male and female or younger and older age were noted and P values were 0.36 and 0.98 respectively.
5 patients with early stage were treated by hyperfractionation radiotherapy from 1991 to 1992. They have had good local control with a minimum follow-up of 24 months but it needs more time to follow up.

並列關鍵字

Vocal cord carcinoma ； Radiotherapy