腮腺癌术后放疗价值探讨

Evaluation of postoperative radiotherapy for Carcinoma of Parotid grand

目的 :评价腮腺癌术后放疗的价值。方法 :1984～ 1996年本院收治腮腺癌患者 15 8例 ,行单纯手术 5 8例 ,术后放疗 10 0例。治疗后予以再次手术和 /或放疗的分别为前者 4 3例 ,后者 38例。结果 :单纯手术和术后配合放疗 5年生存率 ,分别为 5 6 90 %和 6 8% (P >0 0 5 ) ,腺癌、腺泡细胞癌和恶性混合瘤等恶性度较高者 ,术后放疗可提高 5年生存率 (P <0 0 5 % )。外侵与面神经受累者 ,术后放疗可减少 3年及 5年的复发率 (P <0 0 1) ,而病灶局限且无面神经受累者及颈部淋巴结转移者 ,术后放疗价值不大。单纯手术后复发 ,再次手术并辅以放疗能提高 3年继续生存率并减少 3年再复发率 (P <0 0 5 ) ;而术后放疗后复发 ,再次放疗价值不大 ,反而导致严重的放疗副反应。结论 :病理恶性度较高以及肿瘤外侵或面神经受累者 ,应予以术后放疗 ;术后放疗后复发 ,再次放疗价值不大 ,反而导致严重的放疗副反应。

Objective:To study the effect of postoperative radiotherapy for Carcinoma of Parotid grand.Methods:158 Patients treated from 1984 to 1996 in our hospital were observed, of which 58 received operation only (OT), 100 postoperative radiotherapy(RT). The recurrence patients were treated by operative only again (OTA) or surgery combined RT again (RTA).Results:(1) The 5 year survival rates of OT and RT were 56 90% and 68% ( P >0 05), respectively. However, the 5 year survival rates of the patients, whose pathological degrees of differentiation were higher, such as adenocarcinoma, acinar cell carcinoma and malignant mixed tumors, when treatd by RT, were improved ( P <0 05). (2) The 3 and 5 year recurrence rates were decreased of RT patients with external invasions of tumor and whose facial nerve were infiltrated( P <0 01), but there was no helpful for the RT patients without external invasions or with metastasis of lymphonodi cervicales. (3) RTA for the recurrence of OT could increase the 3 year continual survival rate and lower the 3 year again recurrence rate( P <0 05). But it was use for the recurrence of RT, instead, it could give rise to some serious side effects of radiation.Conclusion:It was suggested to receive RT for the patients whose pathological degrees of differentiation were higher and those with external invasions of tumor and whose facial nerve were infiltrated. RTA was use for the recurrence of RT, instead, it could give rise to some serious side effects of radiation.