T3和T4期梨状窝癌的综合治疗

Comprehensive treatment of advanced pyriformsinus cancer

目的评价不同治疗方式治疗梨状窝癌T3、T4病变的治疗效果。方法回顾性分析了1974年1月—1999年12月中国医学科学院肿瘤医院头颈外科初治的287例T3、T4梨状窝癌患者。根据治疗方式,分为4组:单纯放疗组(Ra组)134例,平均放疗剂量68.8 Gy;术前放疗加手术组(R+S组)125例,平均术前放疗剂量45.5 Gy,其中32例行喉功能保留手术;单纯手术组(Sa组)13例,全部为非喉功能保留手术;手术加术后放疗组(S+R组)15例,全部为非喉功能保留手术,平均术后放疗剂量56.3 Gy。结果Kap lan-M e ier方法计算Ra组、R+S组、Sa组和S+R组的5年生存率分别为23.13%、46.51%、18.33%和44.44%。综合治疗(R+S组和S+R组)与单纯治疗(Ra组和Sa组)的5年生存率分别为46.22%和22.60%。,两组间差异有统计学意义(P=0.000)。Cox模型对生存时间的多因素分析显示,对生存时间有影响的是治疗模式(P=0.000)和放疗效果(P=0.0070)Ra组、R+S组、Sa组和S+R组的喉功能保存率分别为14.08%、13.61%、0和0。Ra组、R+S组、Sa组和S+R组的并发症的发生率分别为14.93%、37.60%、53.84%、33.33%。结论术前放疗有助于T3、T4梨状窝癌患者喉功能的保留。

Objective To evaluate the treatment results of advanced pyriform sinus cancer according to therapy modalities. Methods Two hundred and eighty seven patients with locally advanced pyriform sinus cancer were included in this retrospective analysis. One hundred and thirty four patients were treated with radiotherapy alone （Ra group） with 68.8 Gy. One hundred and twenty five patients were treated with preoperation radiotherapy with 45.5 Gy followed by surgery including 32 laryngeal function sparing surgery （R ＋ S group）. Thirteen patients were treated with surgery alone （Sa group）. Fifteen patients were treated with surgery followed by post-operation radiotherapy with 56.3 Gy （S ＋ R group）. There was no laryngeal function sparing surgery in the last two groups. Results Survival rate and laryngeal sparing rate were calculated using Kaplan-Meier method. The overall 5-year survival rates were 23.13% for Ra group, 46.51% for R ＋ S group, 18.33% for Sa group and 44.44% for S ＋ R group, 46.2% for combined therapy group （R ＋ S group and S ＋ R group） and 22.60% for single therapy group （Sa group and Ra group）. There was statistical difference between combined therapy group and single therapy group （P = 0.000）. Laryngeal sparing rate were 14.08%, 13.61%, 0 and 0, respectively. R ＋ S group showed superiority over Ra group, Sa group and S ＋ R group in teams of both overall survival rate and laryngeal sparing rate. Laryngeal funetionspare was analyzed using Cox model. Therapy mode is the most important factor that contribute to laryngeal sparing. No significant differences were found in complication rate among the groups. Conclusion Preoperation radiotherapy conduces to preserve laryngeal function of patients with locally advanced pyriform sinus carcinoma.