Comparison of Clinical Outcome in Hypopharyngeal Cancer Treated with Radiotherapy Alone or Surgery Combined with Adjuvant Radiotherapy- 10 Years, Experience in Mackay Memorial Hospital

下咽癌接受單獨性放射線治療或手術合併術後放射線治療之臨床結果比較—馬偕醫院十年經驗

王銘志(Ming-Chih Wang) ； 呂宜興(Yi-Shing Leu) ； 張國華(Kuo-Hwa Chang) ； 賴允亮(Yuen-Lainag Lai) ； 鍾昌宏(Chang-Hung Chung) ； 吳孟浩(Meng-Hao Wu) ； 陳裕仁(Yu-Jen Chen)

《放射治療與腫瘤學》 5卷4期 (1998/12) Pp. 253-259

https://doi.org/10.6316/TRO/199805(4)253

摘要

目的：針對下咽癌接受單獨性放射線治療或手術合併術後放射線治療，評估其治療結果，並分析組織學上之預後因子。
材料與方法：自1987年1月至1997年12月，在本院接受單獨性放射線治療或手術合併術後放射線治療的81位下咽癌病患，作回溯性的分析，其中男性占79位，女性2位，年齡介於24至80歲（中間值54）。其腫瘤第一期至四期分別為0，3，22及56位，這兩組病患之T-期與N-期分佈上並無明顯差異，其中18位病患接受單獨性放射線治療，每天1.8Gy，放射線治療之平均劑量為63.9 Gy（介於34.2至75.6 Gy），另外63位病患接受全喉切除術合併部分咽喉切除或食道切除術，這些病患皆接受輔助性放射線治療，平均劑量為60.4 Gy（介於36至738 Gy）。
結果：接受手術合併術後放射線治療之病患的5年存活率為33% ，接受單獨性放射線治療病患的5年存活率為30%，這兩組存活率無明顯差異。接受手術合併術後放射線治療之病患的5年局部控制率為52% ，而接受單獨性放射線治療病患的5年局部控制率為40% ，其有統計學上差異(p=0.015)。多因子分析確認神經侵犯與壞死為重要的預後因子。
結論：手術合併術後放射線治療比單獨性放射線治療有較好的局部控制率，但對存活率無明顯差異，神經侵犯與壞死為有意義之預後因子。

關鍵字

下咽癌 ； 放射線治療 ； 手術

並列摘要

Purpose: To evaluate treatment results and analyze pathological prognostic factors in surgery plus postoperative radiotherapy and radiotherapy alone for hypopharyngeal cancer.
Materials and Methods: This retrospective analysis is based on the clinical outcome of 81 patients with hypopharyngeal cancer treated with surgery plus adjuvant radiotherapy and radiotherapy alone from January 1987 to December 1997. There were 79 males and 2 females, between 24 and 80 years old (median: 54). The numbers of patients in stages I to IV were 0, 3, 22 and 56, respectively. There were no significant difference in T- and N-distributions between the two treatment groups. Radiotherapy alone was used in 18 patients with 1.8 Gy pen fraction per day to a mean total dose of 63.9 Gy (range 34.2 to 75.6 Gy). Surgical treatment for 63 patients consisted of total laryngectomy with partial or total pharyngectomy and esophagectomy when indicated. These patients received ad]uvant radiotherapy to a mean dose of 60.4Gy (range 36 to 73.8 Gy).
Results: The 5-year survival rates were 33% for patients treated with surgery plus adjuvant radiotherapy and 30% for patients treated with radiotherapy alone. There was no significant difference in survival between the two treatment groups. The local control rate at 5 years was 52% for patients treated with surgery plus adjuvant radiotherapy, compared with 40% for patients treated with radiotherapy alone with a significant difference (p = 0.015). Multivariate analysis identified that perineural invasion and necrosis are the significant predictors of poorer survival.
Conclusion: The combination of surgery plus radiotherapy results in a better locoregional control than radiotherapy alone, but dose not yield a better survival. Perineural invasion and necrosis are associated with poorer survival.

並列關鍵字

Hypopharyngeal cancer ； Radiotherapy ； Surgery