90例皮肤癌放射治疗临床分析

Irradiation for Skin Carcinoma:Analysis of 90 Cases

目的 回顾性分析单纯放射治疗的皮肤癌病例。探讨其临床疗效、美容效果及影响因素。方法 对1986年1月～1992年12月经病理证实,单纯放射治疗的皮肤癌共90例进行了回顾性分析。结果 总的5年生存率为68.9%,其中:T1期93.3%,T2期75%,T3期556%,T4期375%。T分型越早,5年生存率越高(P<0.05)。基底细胞癌5年生存率811%,鳞状细胞癌5年生存率60.4%,基底细胞癌5年生存率高于鳞状细胞癌(P<0.05)。照射剂量<60Gy5年生存率38.5%,60～70Gy为742%,>70Gy为714%,<60Gy组5年生存率低于60～70Gy组(P<0.05);>70Gy组与60～70Gy组5年生存率相仿(P>0.05)。浅层X线与电子束治疗5年生存率分别为667%及718%,差异无意义(P>0.05)。1度、2度、3度远期放射性皮肤反应在浅层X组分别为533%、367%、10%,电子束组分别为843%、125%、31%,浅层X线组美容效果较电子束组差(P<005)。结论 皮肤癌放射治疗的疗效与T分期、病理类型有关,照射剂量以60～70Gy/6～7周为宜。电子束治疗皮肤癌在美容效果方面优于浅层X线。

Objective A retrospective analysis was carried out to evaluate the results and cosmesis of skin carcinoma treated by radiation alone.Methods From Jan.1986 to Dec.1992,90 patients with histologically confirmed basal cell and squamous cell carcinomas of skin were treated by radiation alone with either superficial X rays or electron beam.13 patients received a dose below 60 Gy.70 patients received a dose between 60 and 70 Gy.7 patients received a dose above 70 Gy.The fraction dose was 2Gy.Five times per week.Results The overall 5 year survival rate was 68.9%.The 5 year survival rates of stage T1 to T4 were 93.3%,75%,55.6% and 37.5% respectiaely.The 5 year survival rates of basal cell and squamous cell carcinomas of skin were 81.1% and 60.4%.The 5 year survival rates of a dose below 60 Gy,between 60 and 70 Gy and above 70 Gy were 38.5%, 74.2% and 71.4% respectively.The 5 year survival rates of the groups treated with superficial X rays or electron beam were 66.7% and 71.8%. Good cosmesis,fair cosmesis and poor cosmesis in superficial X rays group were 53.3%,36.7% and 10%,in electron beam group were 84.3%, 12.5% and 3.1%.Conclusions The results of skin carcinoma treated by radiation alon have relations with clinic T stage and pathologic type.A total dose between 60 to 70 Gy is better.The overall cosmetic results after electron beam therapy are better than those after superficial X rays.