喉癌术前放射治疗及单纯手术疗效比较

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。     

喉癌组织雄激素受体测定及其意义

采用葡聚糖包被活性炭的放射性配体饱和分析技术（ＤＣＣ法）测定３３例喉癌组织中雄激素受体（ＡＲ）含量，并进行Ｓｃａｔｃｈａｒｄ饱和曲线分析。发现在喉癌组织中存在较高水平的ＡＲ，含量在３～１６．９ｆｍｏｌ／ｍｇ。ｐｒｏ之间（平均为１０±３．９ｆｍｏｌ／ｍｇ．ｐｒｏ），解离常数（Ｋｄ）为１．７×１０－９Ｍ。提示喉癌是类固醇性激素依赖性肿瘤；喉癌组织中ＡＲ对雄激素的超常需求，可能是ＡＲ含量增高并引起肿瘤恶性增殖的结果。用抗雄激素的内分泌疗法治疗喉癌可有一定疗效。     

喉癌病人血清可溶性白细胞介素Ⅱ受体的实验性研究及临床竟义

应用双抗体夹心ＥＬＩＳＡ法测定６７例喉癌，１９例声带息肉患者及３５例正常人血清可溶性白细胞介素Ⅱ受体（ｓＩＬ－２Ｒ）水平，结果表明：喉癌患者的血清ｓＩＬ－２Ｒ水平明显高于声带息肉患者和正常人（Ｐ＜０．０１）。且喉癌病人的血清ｓＩＬ－２Ｒ水平与喉癌的病理分化程度、分型、分期及手术前后均具有明显的相关趋势。提示血清ｓＩＬ－２Ｒ水平的检测可作为喉癌患者临床监测指标之一。     

喉癌患者血清铁蛋白和糖链蛋白测定的临床意义

对喉癌、喉部良性疾病和正常人的血清铁蛋白（ＳＦ）和糖链蛋白（ＣＡ－５０）进行了测定，发现喉癌ＳＦ水平明显升高（Ｐ〈０．０１）。经手术治疗后ＳＦ水平下降；但疗效差、肿瘤复发者ＳＦ水平则升高。ＳＦ还和喉癌的ＴＮＭ分期有关，同血清铁无关。上述各组的ＣＡ－５０水平均低于正常值１７Ｕ／ｍｌ，组间比较亦无统计学差异（Ｐ〉０．０５）。提示ＳＦ和ＣＡ－５０水平测定有一定的临床意义。     

维甲酸对人喉鳞癌裸鼠移植瘤的治疗观察

目的 寻求有效的喉癌辅助治疗方法,研究全反式维甲酸（ＲＡ）在体内的抗肿瘤作用。方法 利用人喉鳞癌瘤系ＰＨＣ３制造裸鼠喉癌模型（裸鼠１６只,实验治疗组和对照组各８只）,观察ＲＡ治疗荷喉癌裸鼠的疗效,并在光镜及透射电镜下观察ＲＡ作用后肿瘤组织显微及超微结构,免疫组化检测肿瘤细胞ｃ－ｍｙｃ蛋白的阳性率。结果 治疗组肿瘤生长明显受到抑制,抑制率达５０％以上（Ｐ〈０．０５）。光镜及透射电镜观察发现,ＲＡ治疗     

垂直部分喉切除术后声功能的客观定量评价

为客观定量评价喉癌生趣部分喉切除术后患者的发音功能，采用喉声气流仪分别对行垂直半喉切除术后的喉癌患者３０例（按术后２年，３￣１０年分为Ａ、Ｂ两组），和正常男性（Ｃ组）３０例进行声功能测试。结果显示：Ａ、Ｂ组与Ｃ组比较平均气流率（ＭＦＲ）、声强、最长发音时间（ＭＰＴ）有极显著性差异（Ｐ〈０．０１）；发声频率之间有显著性差异（Ｐ〈０．０５）；Ａ组与Ｂ组比较其声强、ＭＦＲ、ＭＰＴ有极显著性差异（Ｐ〈０．     

喉癌患者血清可溶性白细胞介素—2受体和肿瘤坏死因子水平的研究

应用单克隆、多克菌双抗体夹心ＥＬＩＳＡ检测了３５例喉鳞癌患者的血清可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）和肿瘤坏死因子（ＴＮＦ－α）水平。结果显示：喉癌患者ｓＩＬ－２Ｒ水平较良性组可正常人显著升高（Ｐ〈０．００１），与喉吕临床分期、临床分型及淋巴结转移密度相关；喉癌患者ＴＮＦ－α水平只有Ⅳ期显著高于良性组或正常人（Ｐ〈０．０５）。提示：血清ｓＩＬ－２Ｒ水平检测可作为喉癌诊断的一项辅助指标，并有助于     

喉癌患者血清唾液酸测定的临床意义

采用比色法对６１例喉鳞状细胞癌、２５例喉及颈部良性病变患者和４０例正常人的血清唾液酸（ＳＡ）含量进行测定。结果表明，喉癌患者血清ＳＡ含量高于良性病变患者和正常人，差异有极显著性意义（Ｐ＜０．０１）。以大于正常人血清ＳＡ含量的ｘ＋２ｓ为阳性，喉癌患者血清ＳＡ阳性率为６７．５％，良性疾病患者阳性率为１６．０％，差异有极显著性意义（Ｐ＜０．０１）。此外，血清ＳＡ含量与喉癌患者的临床分期及预后密切相关。提     

喉部肿瘤AgNOR定量研究

应用银染技术对４４例喉癌，７例喉乳头状瘤，８例喉正常粘膜的石蜡切片行核仁组成区相关嗜银蛋白（ＡｇＮＯＲ）含量分析，结果表明：喉癌，喉乳头状瘤，喉正常粘膜之间ＡｇＮＯＲ含量均有显著性差异：ＡｇＮＯＲ含量与喉癌组织学分级，临床分期相关：分析有随访资料的３０例喉癌患者ＡｇＮＯＲ含量，发现术后３年内死亡的１３例和仍存活的１７例病人癌组织中ＡｇＮＯＲ含量有极显著性差异。提示：ＡｇＮＯＲ含量可作为喉良恶性肿鉴     

原位免位PCR检测喉癌中人类乳头状瘤病毒E6蛋白

针对常规免疫组化检测石蜡包埋的喉癌组织中人类乳头状瘤病毒（ＨＰＶ）１６／１８型Ｅ６蛋白阳性率低、信号模糊等缺点，我们探索出一种敏感而有效的检测方法———原位免疫ＰＣＲ（ＩｎＳｉｔｕＩｍｍｕｎｏ－ＰＣＲ，ＩＳＩ－ＰＣＲ），报告如下：１　材料与方法１．１　材料：９例１６／１８型ＨＰＶＤＮＡ阳性的喉癌高分化鳞癌石蜡包埋组织。生物素标记ＰａＴＥＬ１４／ＥｃｏＲＩＤＮＡ片断。ＰＣＲ引物：５’－ＡＴＡＣＣＴＡＴＴＧＣＣＴＡＣＧＧＣＡＧ－３’；５’－ＣＧＴＴＡＧＴＡＡＡＴＧＡＡＴＴＴＴＣＴ－３’。１．２　方法…     

喉声门上型低分化鳞状细胞癌57例临床观察

目的 探讨喉声门上型低分化鳞状细胞癌(简称鳞癌)的临床特点、治疗及预后。方法 回顾分析1980～1998年我院57例喉声门上型低分化鳞癌病例(1997年UICC分期：Ⅰ期4例，Ⅱ期5例，Ⅲ期18例，Ⅳ期30例)。单纯手术25例，单纯放射治疗9例，术前放射治疗加手术14例，手术加术后放射治疗7例，术前化学治疗加手术2例。喉全切除23例，喉部分切除25例；同期颈清扫31例(单侧17例，双侧14例)，上颈清扫12例。结果5年生存率47．4％(27／57)，颈部转移率63．2％(36／57)，双颈转移率24．6％(14／57)，远处转移率21．1％(12／57)，局部复发率10．5％(6／57)，颈部复发率28．1％(16／57)，喉部分切除的局部复发率12．0％(3／25)。生存率随分期下降，T1 T2与13 T4和N0 N1与N2 N3的生存率差异分别有显著性(χ^2=4．942，P=0．026；χ^2=4．306，P=0．038)。单纯手术与手术结合放射治疗的生存率差异无显著性，N2和N3患者的手术结合放射治疗相对优于单纯手术。结论 喉声门上型低分化鳞癌患者以晚期病变为主，易较早发生淋巴结转移，颈部转移和远处转移率较高，治疗仍以手术为主，喉部分切除术是可行的，T3病变的喉部分切除和颈部N分级较晚的患者应手术结合放射治疗。     

Planned preoperative radiation therapy vs. definitive radiotherapy for advanced laryngeal carcinoma

In the period 1970-1980 inclusive, 191 patients with T3T4 laryngeal carcinoma (glottic: 63 and supraglottic: 128) received either definitive radiation therapy (RT) (60-65 Gy in 6-7 weeks) or planned preoperative radiation therapy (25 Gy in 5 equal daily fractions of 5 Gy) followed by laryngectomy with or without neck dissection (RT + S). Selection for RT vs. RT + S was based on medical operability and/or patient's refusal to undergo surgery. All patients are evaluable with minimum of 2 years observation. Crude 5 and 10-year survival probability for 32 patients with glottic localization who received RT is 55% and 38% vs. 65% and 65% respectively for 31 treated with RT + S. For 52 patients with supraglottic site who received RT, the 5 and 10-year survival is 44% and 44% vs. 82% and 60% for 76 patients treated with RT + S.     

Exclusive surgery versus postoperative radiotherapy for supraglottic cancer

AIM OF THE STUDY: To verify the effectiveness of prophylactic postoperative radiotherapy for supraglottic cancer. PATIENTS AND METHODS: 97 patients underwent supraglottic horizontal laryngectomy with bilateral neck dissection: 35 patients (group A) received postoperative radiotherapy (60-70 Gy, 2 Gy fractions daily); 62 patients (group B) received only surgery. RESULTS: Overall 5-year actuarial survival and corrected actuarial survival rates were 74 and 90% in group A and 61 and 80% in group B (p = 0.2 and 0.4, respectively). As for tumor extent, no significant differences were observed between the two groups. In N0 patients overall actuarial survival rate was significantly higher in group A as compared to group B (p = 0.01); most likely this difference was due to errors in clinical staging for the presence of reactive lymphadenitis and micrometastases. CONCLUSIONS: The present study did not document the effectiveness of postoperative radiotherapy. Radiation therapy should be avoided in those patients in whom surgery was proven to be curative while it could be considered in combination with surgery when the resection margins are dubious and/or inadequate.     

手术加放射治疗与单纯喉部分切除术治疗喉癌的疗效比较

目的 探讨手术加放射治疗能否比单纯部分喉手术提高疗效。方法 １７１例喉癌随机分为单纯手术,手术加术后放射治疗（剂量５１－７０Ｇｙ）和放射治疗加手术（剂量４０－５０Ｇｙ）３组,前瞻性观察各组的治疗效果。术式包括：声带切除术,垂直半喉切除术,水平半喉切除术,次全喉切除术。结果 单纯手术组（５６例）,手术加术后放射治疗组（６５例）和术前放射治疗加手术组（５０例）的５年生存率分别为８５．７％（４２／４９）     

Endoscopic CO2 laser therapy of selected cases of supraglottic marginal tumors

Endoscopic CO₂ laser intervention can be used as conservation surgery for supraglottic laryngeal carcinomas in carefully selected patients. We analyzed retrospectively our experience in managing patients with early supraglottic carcinomas operated on at the Clinic of Otorhinolaryngology, Szeged, Hungary, during the 10-year period between 1987 and 1997. Conservation surgery was the treatment of choice in 187 patients, but only 23 (12%) were selected for endoscopic CO₂ laser surgery. Laser surgery was indicated predominantly for T1 cancer of the epiglottis (n = 15), but was also performed for T2 cancers (n = 8). Of the 23 supraglottic tumors treated, 16 had no signs of recurrence to date (1.5 to 9 years after surgery) a local control rate of 70%. Six patients with recurrences underwent salvage therapies that included repeated laser excisions (n = 3), radiotherapy (to 60 Gy), horizontal supraglottic laryngectomy and total laryngectomy. One patient was not resectable because of multiple metastases. Our experience with endolaryngeal CO₂ laser excision indicates that it is a reasonable method in selected cases of supraglottic tumors, but one-third of the patients required salvage treatment. Recieved: 28 September 1998 / Accepted: 15 March 1999     

59例晚期声门上型喉鳞状细胞癌治疗和临床疗效分析

目的：比较手术加辅助放疗与单纯手术治疗晚期声门上型喉鳞状细胞癌的疗效。方法：将59例晚期声门上型喉鳞状细胞癌按治疗方法分为手术＋放疗组（33例）和手术组（26例）。手术＋放疗组全喉切除27例,部分切除6例,其中27例行侧颈淋巴结清扫术;手术组全喉切除23例,部分切除3例,其中24例行侧颈淋巴结清扫术。结果：手术＋放疗组和手术组的3年总生存率分别为62．6％和62．6％,5年总生存率分别为43．8％和40．5％,经Log—rank检验两组之间的生存率差异无统计学意义（P〉0．05）。手术＋放疗组5例复发,复发率15．2％;手术组10例复发,复发率38．5％,两组的复发率差异有统计学意义（P〈0．05）。结论：手术加辅助放疗未能提高晚期声门上型喉鳞状细胞癌3、5年总生存率,但明显降低肿瘤复发率。     

Results of treatment of 584 laryngeal cancers at the Ear-Nose-Throat Clinic of Marburg University

The results in the management of 460 vocal cord carcinomas and 124 supraglottic carcinomas are reported. Of the vocal cord carcinomas, 63.3% were diagnosed in the early Tis and T1 stage. Seventy-six tumors were resected endoscopically, 128 by laryngofissure and chordectomy. Not one of these patients has lost his life, larynx or voice. In bilateral tumors of the T1b category, 2 patients developed local recurrences and lost their larynx. Sixty-two carcinomas of the Tis, T1a and T1b categories were irradiated primarily. Two of these patients died and 14 underwent laryngectomy for local recurrence. In T2 carcinomas a 5-year cure rate of 87.5% was achieved by vertical partial resection. The 5-year cure rate after laryngectomy or laryngectomy with neck dissection for T2N0 and T2N+ carcinoma was 86.2% and 75.0% respectively. Most treatment failures were due to late metastases which could not be controlled. In T3 carcinomas with a 5-year cure rate of 71.4% (N0) and 70.0% (N+) respectively, treatment failures were also mainly seen in patients with N0 necks where we did not carry out a prophylactic neck dissection. Five-year survival rates for primary surgery in supraglottic T1-T4 carcinomas were 100%, 82.4%, 84% and 58.3%. The widely hel opinion that laryngeal carcinoma should only be subjected to surgery for irradiation failure can no longer be sustained. More patients lose their larynx or their life after irradiation of small carcinomas than after primary surgery. Furthermore, too many patients have to undergo two major cancer treatments (irradiation and salvage surgery). In larger carcinomas radiotherapy produces a lower survival rate and too many patients require two stressful cancer therapies. The number of retained larynges is not substantially higher than with primary surgery. Primary irradiation for selected cases should be part of every therapy concept that aims at an adequate and individual treatment of every patient.     

Surgical treatment of pyriform sinus cancer: A retrospective study

Patients with squamous cell carcinoma of the pyriform sinus treated surgically from 1959 through 1979 at the University of California, San Francisco were reviewed. As several reports had previously suggested that the addition of radiation therapy, preoperatively or postoperatively, did not increase survival, our data collection and analysis was performed in such a way as to determine whether similar trends were present in our patients. Data were tabulated for patients having: 1. surgery alone (SA); 2. preoperative radiation and surgery (RS); and 3. surgery and postoperative radiation (SR). The surgery alone group demonstrated the best results, with 65% 3-year determinant survival, and 56% 5-year survival, compared to 50% 3-year and 33% 5-year survivals in the combined groups. In this patient population, the increased death rate in the combined therapy group appeared to be due primarily to a higher distant metastasis rate (50% vs. 26% for the surgery alone group). Although our numbers are too small for any of the comparisons to be significant, the findings of similar cure rates of pyriform sinus cancers by surgery alone support similar data from other authors. As staging was similar in the two groups, and none of the other variables examined appeared to explain these results, we could only conclude that further data is needed, and that the exact role of radiation therapy, in combination with surgery for pyriform sinus cancer remains to be defined.     

Treatment of hypopharyngeal carcinomas--an institutional analysis of the results of FAR radiochemotherapy, radical resection, and free jejunum flap reconstruction and the indication of neck dissection

The treatment results of 65 patients with hypopharyngeal carcinomas treated at our institute between 1995 and 2000 were analyzed. In general, concurrent radiochemotherapy (RCT), consisting of intravenous 5-FU injection, intra-muscular vitamin A injection, and radiation (FAR therapy) was used as an initial treatment for advanced hypopharyngeal carcinomas and early hypopharyngeal carcinomas. Tumor responses were evaluated at the time of radiation doses of 30Gy. Patients who showed a complete response (CR) subsequently received curative radiation doses of 60 to 70Gy. Patients who did not show a CR underwent radical surgery consisting of pharyngo-laryngo-cervical esophagectomy, neck dissection for positive cervical nodes and/or the primary tumor sides, and reconstruction using a free jejunum flap. The disease-specific 5-year survival rates were 92%, 55%, 35% and 49% for stage I/II, III, IV and all cases, respectively. Eight out of 9 patients with stage I/II disease who showed a CR after receiving 30Gy of RCT survived with an intact larynx after definitive RCT. All the patients with stage II/III disease who underwent radical surgery after receiving 30Gy of RCT did not have a recurrence, whereas the 5-year survival rate of patients with stage IV disease who underwent RCT and radical surgery was 45%. Seventeen out of 19 patients with clinically negative cervical nodes on the opposite side of their primary tumors showed no nodal metastasis after RCT without neck dissection. This result suggests that elective neck dissection after RCT is not necessary. To improve the treatment results for hypopharyngeal carcinomas, early detection of this disease is prerequisite. In addition, the clinical diagnosis of highly malignant cases and new molecular-targeted therapies based on an analysis of distant metastasis mechanisms should be developed to overcome the poor prognosis of advanced hypopharyngeal carcinomas.