声门上喉鳞癌临床颈淋巴结阳性患者术前放疗对颈部复发的影响：随机对照研究

Preoperative radiotherapy for supraglottic carcinoma with clinically positive cervical lymphadenopathy──A randomized study

声门上型喉鳞癌临床颈淋巴结阳性患者８１例，随机对照研究术前放疗４０Ｇｙ对控制颈部复发的意义。放疗加手术３２例，单纯手术４９例，随诊３年以上。颈部为复发的主要部位占６２．９％，放疗加手术组颈部复发率２１．８％，单纯手术组３０．６％，但无统计学差异（Ｐ＝０．９）。两组颈部复发率与Ｔ分期和Ｎ分期（除Ｎ＿３外）大小无明显关系。因此术前４０Ｇｙ对颈部复发无显著意义，建议对所有患者做临床阳性侧颈清扫术，术前放疗剂量提高到５０Ｇｙ，或术后放疗６０Ｇｙ以上。

Abstract A prospective randomized study of 8 1 patients with N+ supraglottic squamous carcino-ma was performed to evaluate the control of regional recurrence by 4 0 Gy dose preoperative radiotherapy. All patients were followed up for at least 3 years. Surgery alone was used to treat 49 patients,and combined therapy in 32 patients. Occurence of failure in the neck was 30.6%and 21.8%respectively,which is no statistically significance(P=0. 9).The T and N stages did not alter the rate of regional recurrence,excluding N3 lesions. We propose that routine neck dissection is performed on the N+ side and increasing the radiation dose up to 60Gy for postoperative or 50Gy for preoperative radiotherapy.