Treatment Results of Oral Tongue Cancer

舌癌之治療結果

黃昭源(Chao-Yuan Huang) ； 雷德(Louis Tak Lui) ； 王博民(Po-Ming Wang) ； 鍾娜娜(Na-Na Chung) ； 丁禮莉(Lai-Lei Ting)

《放射治療與腫瘤學》 4卷1期 (1997/03) Pp. 23-30

https://doi.org/10.6316/TRO/199704(1)23

摘要

目的：探討舌癌病患在台大醫院治療之結果。
材料與方法：本研究共蒐集了自1977至1994年間161位舌癌病患進行分析。治療方式包括手術治療（85位）、放射治療（40位）和合併手術及放射治療（36位）。屬於第一期33位（20%）；第二期53位（33%）；第三期37位（23%）；第四期38位（24%）。全部病患皆經過病理診斷為扁平細胞癌；男女比例4：1。我們分析比較腫瘤原發處與頸部淋巴結的控制效果、預後和併發症。
結果：超過五分之四的腫瘤位於舌邊，少於5%位於舌表面與舌腹。T1、T2接受手術的病患，原發腫瘤控制率很好，分別是90%和86%。T3以合併治療的效果較好，控制率是67%；T4的治療效果都很差。即使是早期病患，只接受手術切除腫瘤而無進一步處理頸部淋巴結，則易在頸部復發。第三期病患的五年存活率分別是：手術治療24％，放射治療17%，合併手術與放射治療61%。T3、T4復發的病患當中，復發於一年內的佔84%；T1、T2復發的病患當中，復發於一年內的佔72％。全部復發的病患中，86%復發於兩年內。共有十位六病患(10%)遠端轉移，肺轉移佔最多(75%)。發生骨質糜爛在合併治療組(6%)的危險性與放射治療組(3%)相似。
結論：我們的分析結果：手術治療能有效控制T1、T2的原發腫瘤。T3、T4單以手術或放射治療效果不佳，最好合併治療。第三期的病患當中，合併治療組的五年存活率優於其他兩組(P＜0.05)。舌部的淋巴豐富，所以腫瘤易轉移到局部淋巴結。如果只接受手術切除腫瘤，要注意頸部的追蹤檢查以防復發；功能性頸部淋巴摘除或術後放射治療也是很好的選擇。仍有14%的復發於兩年後才發現，所以長期追蹤很重要。

關鍵字

舌癌 ； 原發與頸部腫瘤控制率 ； 併發症 ； 五年存活率

並列摘要

Purpose: To evaluate the therapeutic results of oral tongue cancer patients treated with curative intent at the National Taiwan University Hospital.
Materials and Methods: From 1977 to 1994, 161 oral tongue cancer patients were treated by different modalities, including surgery alone (85 patients), radiotherapy alone (40 patients) and surgery followed by radiotherapy (36 patients). Patients were grouped according to the American Joint Committee on Cancer (AJCC) staging system. Among these 161 patients, 33 (20%) were categorized as stage I; 53 (33%) stage II; 37 (23%) stage III and 38 (24%) stage IV. All of them were squamous cell carcinoma with a male to female ratio of approximately 4:1. The treatment results of primary control, neck node control, outcomes and complications were analyzed.
Results: More than four fifths of the lesions were located on the lateral border of the tongue and less than 5% were either on the dorsum or undersurface. Primary control rates of Ti and T2 diseases in the OP alone group were 90% and 86%, respectively. The T3 patients of OP+REF group had better primary control rate as 67%. Primary control of T4 disease was very poor hi our three treatment groups. Even for the early disease, patients receiving surgical resection of primary tumor without further neck treatment have a higher risk (28%) of neck failure. Five-year survival rates of stage Ⅲ patients were: R/T alone, 17%; OP alone, 24%; OP+R/T, 61%. Eighty-four percent and 72% recurrence in T3/T4 and T1/T2, respectively, occurred within one year after treatment. Overall, 86% recurrence occurred within the first 2 years. Sixteen patients (10%) showed evidence of distant metastasis; most commonly presented in the lung (75%). The risk of osteonecrosis was similar between OP+R/T group (6%) and R/T alone group (3%).
Conclusion: In our study, surgery can control primary tumors effectively in Ti and T2 lesions. Advanced (T3 and T4) disease is unlikely to be cured by radiation therapy or surgery alone and therefore is best managed by a planned combination of surgery and radiation therapy. For stageⅢ group, five-year survival rate was significantly improved (p＜O.O5) for patients who were treated with surgery and postoperative radiotherapy. When the primary lesion is treated by simple excision, neck failure is not uncommon and adjuvant radiotherapy to the neck lymphatics may decrease its occurrence. There was 14% of recurrence occurred beyond the first 2 years which indicated that a long period of follow-up was important for tongue cancer patients.

並列關鍵字

Oral Tongue Cancer ； Primary and Neck Control ； Com-Plications of Treatment ； Five-year Survival Rate