颌骨原发性骨内癌术后放射治疗初探

Postoperative radiotherapy for primary intraosseous carcinoma of the jaws

目的探讨颌骨原发性骨内癌(PIOC)术后放射治疗的适应证、照射范围和剂量。方法收集中国医学科学院肿瘤医院1969年10月-2005年5月治疗的13例PIOC的临床资料,并综合1969-2005年国内外27篇文献所报道的资料较为完整的46例PIOC(共59例)进行分析。结果(1)中国医学科学院肿瘤医院收治的13例PIOC均为局部晚期,1、2和3年生存率分别为59.2%、33.8%和12.7%。(2)59例PIOC 1、2和3年生存率分别为78.4%、53.9%和34.0%,其中单纯手术组1、2和3年生存率分别为81.8%、71.2%和35.1%,手术加放疗组分别为84.3%、57.2%和43.6%,两组生存率差异无统计学意义(P=0.908),但两组病例选择存在很大偏倚。分层分析显示,对于T1和T2期患者,单纯手术组的生存率高于手术加放疗组(P=0.039)。结论术后放疗可能对改善PIOC患者,尤其是T3期、颈淋巴结阳性、行局部切除术或切缘不净的PIOC患者的生存具有一定作用,其适应证为手术切缘阳性、原发灶侵及周围软组织、颈淋巴结发生转移、行病灶局部切除。

Objective To investigate the indication, location and dose of postoperative radiotherapy for primary intraosseous carcinoma （PIOC） of the jaws. Methods From October 1969 to November 2005, 13 patients with PIOC were treated at the Cancer Hospital of Chinese Academy of Medical Sciences. Forty six cases with complete clinical data were collected from 27 published reports. Twenty-seven of the 59 patients were treated with surgery plus postoperative radiotherapy, and 22 with surgery alone. Results All of the 13 cases in our series had advanced disease, and overall 1-, 2- and 3-year survival rats were 59.2% , 33.8% and 12.7%, respectively. For the reported 59 cases in literature, the overall 1-, 2- and 3-year survival rats were 78.4%, 53.9% and 34.0%, respectively. They were 84.3%, 57.2% and 43.6% for the patients treated by surgery plus postoperative radiotherapy, whereas they were 81.8%, 71.2% and 35.1% for the patients by surgery alone （ P = 0. 908 ）. It seemed that surgery plus postoperative radiotherapy could not improve the survival of PIOC patients with involvement of adjacent soft-tissues or positive neck nodes or partial excision of primary tumor when compared with surgery alone, if the bias of selection in the patients for postoperative radiotherapy was neglected. Conclusion Postopreative radiotherapy may improve the survival for the patient with primary intraosseous carcinoma of the jaws. Our suggestion is that postoperative radiotherapy should be applied to the patient with any of the following items ： positive operative margin; tumor involvement of adjacent soft-tissues; positive neck nodes ; partial excision of primary tumor. However, the location and dose of postoperative radiotherapy may be varying at different situation.