108例扁桃体鳞癌治疗效果的回顾性分析

Retrospective Analysis of Effectiveness of Tonsillar Squamous Cell Carcinoma:Report of 108 Cases

背景与目的:扁桃体鳞癌的治疗,是选择根治性放疗加外科挽救手术,还是计划性术前放疗加手术,目前尚无一致观点。在Ⅲ～Ⅳ期扁桃体鳞癌患者中,仅以肿瘤大小和淋巴结转移来判断预后显然不足。为此,本研究旨在总结我院扁桃体鳞癌的治疗效果,并探讨上述两种治疗方法的适应证及影响预后的因素。方法:回顾性总结1984年～2000年我院收治的108例扁桃体鳞癌患者的临床资料,其中根治性放疗加外科挽救手术83例(A组),计划性术前放疗加手术25例(B组)。总结两组的治疗效果及口腔功能损害情况,分析肿瘤的放疗反应与生存率的关系。结果:联合根治术导致不同程度的口腔功能损害,其发生率在A组为24.1%(20/83),在B组达88.0%(22/25)。A组患者的5年生存率为59.3%,B组为55.4%(P=0.706)。放疗后转移淋巴结消失及手术标本有重度放疗反应者,A、B两组的5年生存率分别为73.0%和76.9%(P>0.05)。结论:根治性放疗加挽救性手术使部分扁桃体鳞癌患者避免了联合根治术,在一定程度上保留了口腔功能。放疗后淋巴结的消失情况及组织放疗反应程度可以作为晚期扁桃体鳞癌的预后参考指标。

BACKGROUND &OBJECTIVE: There is a controversy in selecting either radiotherapy plus surgery reserved as salvage (Salvage S) or the planned surgery plus preoperative radiotherapy (Planned R+S) as the treatment modality for the tonsillar squamous cell carcinoma. Among stage Ⅲ Ⅳpatients, the tumor size and the lymph node metastasis were insufficient as the prognostic predictors. The authors retrospectively reviewed the patients with this disease who were treated in Cancer Hospital of Chinese Academy of Medical Sciences to analyze the indications and prognosis of the two treatments. METHODS: A total of 108 patients with biopsy proven tonsillar squamous cell carcinoma were reviewed from 1984 to 2000. The patients were divided into Salvage S group (group A, 83 cases) and Planned R+S group (group B, 25 cases). Treatment outcome and the surgery related oral dysfunctions were compared in the two groups. The relationship between the response to radiotherapy and the survival rate was analyzed. RESULTS: The composite resection that led to oral dysfunction was undertaken for 20 (24.1%) of group A patients and for 22 (88.0%) of group B patients. The 5 year survival rates were 59.3%and 55.4%in group A and group B patients, respectively (P=0.706). The 5 year survival rates were 73.0%and 76.9%in the patients whose lymph nodes and surgical specimen showed obvious response to radiotherapy,respectively. CONCLUSION: The two treatment modalities reached similar survivals. However, compared with the planned surgery, 60%of composite resection would be withdrawn if surgery reserved as salvage, being benefit to the oral function. The responses to radiotherapy in the lymph nodes and the surgical specimen were good predictors of prognosis.