喉癌术前放射治疗及单纯手术疗效比较

Preoperative radiation plus surgery vs. operation alone for laryngeal carcinoma

目的探讨喉癌术前放射治疗加手术的治疗方式能否比单纯手术提高治愈率。方法应用前瞻性的随机分组的方法进行临床试验。初治的喉癌病例（不包括声门型Ｔ１病变），年龄在７５岁以下，不伴有喉梗阻，经过临床检查确定解剖分型、ＴＮＭ分期（１９７８ＵＩＣＣ）及手术类型后，通过抽签的方法将患者分入单纯手术组（ＳＡ组）或综合治疗组（ＲＳ组）进行治疗。结果共完成治疗３７０例，ＳＡ组２１５例，ＲＳ组１５５例。ＳＡ组３年生存率８３．３％，５年生存率８２．６％，１０年生存率８０．３％。ＲＳ组３年生存率７８．９％，５年生存率７６．４％，１０年生存率６８．６％。两组生存率差异无显著性（χ２＝２．６，Ｐ＝０．１）。声门上型喉癌ＩＩ、ＩＶ期两组病例在５年生存率上无区别，１０年生存率ＳＡ组优于ＲＳ组，１０年生存率前者为７３．６％，后者为６３．５％，（χ２＝８．３，Ｐ＝０．００３）。声门上型喉癌Ｔ３、Ｔ４病变行全喉切除的两组５年生存率无区别，１０年生存率则差异有显著性，ＳＡ组为６８％，ＲＳ组为５０％（χ２＝１０．６，Ｐ＝０．０００１）。结论术前放射治疗量４０Ｇｙ不能提高治愈率，而且声门上型喉癌ＩＩ、ＩＶ期病变综合治疗组的１０年生存率低于单纯手术组。

Objective To study the validity of preoperative radiation in improving the survial rate of laryngocarcionoma. Methods A prospective randomized clinical trial was conducted with preoperative radiation plus surgery (RS) as one group and surgery alone (SA) as the other group. The ages of the patients were less than 75 years , and the operative types were decided after clinical examination. The patients were divided into SA or RS group by random. Doses of preoperative irradiation was 40 Gy. Three hundred and seventy patients with laryngocarcinoma were treated, 215 in the SA group; 155 in the RS group. All patients were followed up over three years. Results In SA group, 3 years survival rate was 83.3%, 5 year survival rate 82.6%, 10 year survival rate 80.3%. In RS group, 3 year survival rate was 78.9%, 5 year survival rate 76.4%, 10 year survival rate 68.6%. There is no statistically significant difference in survival rates between twe groups ( P =0.1); but, the 10 year survival rate in SA group was bettter than that in RS group for the stage III and IV supraglottic carcinomas, the former was 73.6% and the latter 63.5%( P =0.003). The 10 year survival rate for the patients with T 3 and T 4 supraglottic carcinomas who underwent total laryngectomy in SA group was better than that in RS group. The former was 68% and the latter 50% ( P =0.0001). Conclusion Preoperative radiotherapy with 40 Gy didn't increase the survival rate of laryngeal carcinoma. The 10 year survival of stages III and IV supraglottic carcinoma in combined treatment group was lower than that in the surgery alone group.