92例晚期上颌窦鳞癌患者的临床疗效分析

背景与目的:晚期上颌窦鳞癌的治疗效果较差,其有效治疗方式目前也尚未有统一意见。本研究旨在探讨晚期上颌窦鳞癌的合理治疗方法。方法:回顾性分析中山大学肿瘤防治中心1978年1月至2001年12月间T3、T4期上颌窦鳞癌患者92例的临床资料,按治疗方式不同,分为单纯放疗组21例,单纯手术组8例,综合治疗组63例(其中手术结合放疗51例,化疗 放疗12例)。结果:单纯放疗组3年和5年生存率分别为19.0%、9.5%,单纯手术组3年和5年生存率分别为25.0%、12.5%,综合治疗组3年和5年生存率分别为46.0%、33.3%。单纯放疗组及单纯手术组分别与综合治疗组比较,其3年和5年生存率的差异均有统计学意义(P<0.05)。在综合治疗组中,术前放疗 手术患者3年和5年生存率分别为33.3%、23.8%,手术 术后放疗患者3年和5年生存率分别为52.9%、47.1%,术前放疗 手术 术后放疗患者3年和5年生存率分别为53.8%、30.8%,化疗 放疗患者3年和5年生存率分别为50.0%、33.3%,在综合治疗组中各不同治疗组合间的临床疗效比较,差异无统计学意义(P>0.05)。结论:晚期上颌窦鳞癌行单一治疗效果较差,行综合治疗效果较好。如何制定以手术为主,有机结合放疗、化疗的最佳治疗模式,还有待进一步探讨。     

The management of squamous cell carcinoma of the neck. The Birmingham UK experience.

AIMS: To review our treatment strategy and outcomes for metastatic squamous cell carcinoma of the neck. METHODS: One hundred and six consecutive patients treated between 1992 and 1998 were analysed retrospectively. The following data were obtained. Demographic details, tumour site, clinical and pathological TMN staging, tumour grade and presence of extracapsular spread, treatment modality (surgery, radiotherapy and chemotherapy), type of neck dissection and complications, 2-year loco-regional control and 5-year overall survival. RESULTS: Ninety-two patients had advanced disease (stages 3 and 4) and of these, 57% had palpable neck metastases. One hundred and six patients underwent a total of 132 neck dissections. Seventy-three patients had post-operative radiotherapy to both sides of the neck and a total of 31 patients took part in the UKHAN 1 trial. Seventy percent of patients achieved 2-year loco-regional control and 63% survived 5-years. CONCLUSION: Metastatic squamous cell carcinoma of the neck can successfully be treated with an aggressive surgical approach and post-operative radiotherapy when indicated. Excellent 2-year loco-regional control and 5-year survival rates are possible.     

Can Synchronous Chemotherapy be Added to Accelerated Hypofractionated Radiotherapy in Patients with Base of Tongue Cancer?

AimTo evaluate the tolerability of synchronous chemotherapy and accelerated hypofractionated radiotherapy in patients with locally advanced squamous cell carcinoma of the base of the tongue.Materials and methodsBetween 1999 and 2004, 43 patients with stage II–IV squamous cell carcinoma of the base of the tongue were treated with a combined modality of radiotherapy (prescribed 55 Gy in 20 fractions), synchronous chemotherapy and in some cases surgical neck dissection. End points were acute and late toxicity, 3 year locoregional control, overall survival, cancer-specific survival and compliance.ResultsThe median follow-up for surviving patients was 3.9 years. All patients completed radiotherapy and 30% received neoadjuvant chemotherapy. The median time for the completion of treatment was 27 days (range 25–36). Overall, only 42% completed the prescribed synchronous chemotherapy. However, compliance increased to 60% in patients who did not receive neoadjuvant chemotherapy. Grade 3 mucositis developed in 90% of patients. Prolonged grade 3 mucositis (>4 weeks) was seen in 24/43 (56%) and none developed grade 4 mucositis. There were no toxic deaths. Feeding tube dependency at 1 year was 14%. The 3 year locoregional control, overall survival and cancer-specific survival were 70, 60 and 60%, respectively. Clinical T staging was most significantly associated with poor overall survival, cancer-specific survival and local control. Distant metastases occurred in 6/43 patients (14%), 5/6 without locoregional recurrence.ConclusionThe addition of synchronous chemotherapy to accelerated hypofractionated radiotherapy consistently led to grade 3 mucositis. Tumour control rates compare well with published outcomes. Higher mucosal toxicity and lower synchronous chemotherapy compliance compared with other series may suggest that this approach is at the limit of patient tolerability. However, the tumour site investigated and the choice of synchronous chemotherapy agent may also be important. Compliance may be improved using intensity-modulated radiotherapy and agents that do not enhance mucosal toxicity. Longer fractionation will probably increase compliance with chemotherapy, particularly when induction is used before synchronous treatment.     

Prognosis and clinicopathological characteristics of Ib-IIb adenocarcinoma of the uterine cervix in patients who have had radical hysterectomy.

AIMS: The aim of the present study was to evaluate the outcome of patients with stage lb-IIb cervical adenocarcinoma treated with radical hysterectomy, and to determine the clinicopathological characteristics of those patients. METHODS: A total of 255 patients with cervical carcinoma stage Ib-IIb (57 adenocarcinoma and 198 squamous cell carcinoma) who had undergone radical hysterectomy were included in this study. Patient survival distribution was calculated using the Kaplan-Meier method. RESULTS: The estimated 5-year survival rate for patients with adenocarcinoma was significantly poorer than that for patients with squamous cell carcinoma (77.9% vs 91.7%). The survival rate in stage Ib patients did not differ between two groups (95.8% vs 94.4% respectively). The incidence of lymph node involvement was significantly higher in patients with adenocarcinoma than in those with squamous cell carcinoma (31.6% vs 14.8%). Among patients receiving post-operative radiotherapy, the survival rate for adenocarcinoma (71.1%) was significantly poorer than that for squamous cell carcinoma (90.0%). When patients underwent radical hysterectomy, the survival rate for stage II patients with adenocarcinoma was significantly poorer than that for patients with squamous cell carcinoma. CONCLUSIONS: The higher incidence of lymph node involvement and lower response to post-operative radiotherapy are considered to be factors of poorer prognosis in cervical adenocarcinoma.     

cN0舌鳞癌患者预后的多因素分析

背景与目的：cNO舌活动部鳞癌的治疗尚存在着争议。本研究的目的就是探讨影响cNO舌活动部鳞癌预后的因素并划分高危人群。方法：收集中山大学肿瘤防治中心1990年1月至1998年3月收治的cNO舌活动部鳞癌患者109例的临床资料,应用Cox多因素回归模型（Cox regression model,Cox模型）分析预后影响因素并计算预后指数（prognostic index,PI）,依据个体化的PI,可将患者分为不同的危险组。结果：患者3年和5年的生存率分别为74．40％和69．31％。多因素分析结果显示cNO舌鳞癌患者的T分期、原发灶治疗方式、组织学分化、年龄和隐匿性颈淋巴转移对预后的影响有统计学意义（P＜0．05）,T分期是影响预后的最主要因素。原发灶综合治疗组优于单纯手术和单纯放疗或者化疗组;老年组、低分化组或者伴有隐匿性颈淋巴结转移组的患者预后较差。根据PI值将患者划分为高危组、中危组和低危组,3组的预后两两之间存在统计学差异（P＜0．05）,3组患者5年生存率分别是83．33％、64．12％和27．65％。结论：T分期、原发灶治疗方式、组织学分化、年龄和隐匿性颈淋巴结转移是影响cNO舌鳞癌预后的主要因素;PI值可用于预测cNO舌鳞癌患者的预后。     

16例原发腮腺鳞癌的治疗与预后

目的回顾分析16例腮腺鳞癌的临床特点和治疗结果,研究原发腮腺鳞癌预后影响因素及恰当的治疗方案。方法搜集1984-2005年收治并经病理证实的原发腮腺鳞癌16例,其中T1期2例,T2期5例,T3期5例,T4期4例。NO期10例,N＋期6例,单一手段治疗组6例（单纯手术5例,单纯放疗1例）,综合治疗组（手术加放疗）10例。结果全组患者在病程中出现颈部淋巴结转移的概率为75%（12/16）,全组3和5年局部控制率、总生存率、无瘤生存率分别为45%和30%、58%和58%、36%和27%。T1～T2和T3～T4期的5年生存分别为100%和29%,（X^2=4．50,P= 0．034）。NO和N＋期的3年总生存率分别为80%和20%（X^2=8．70,P=0．003）,无瘤生存率分别为54%和0（X^2=9．83,P=0．002）。结论原发腮腺鳞癌颈部淋巴结转移概率和局部复发率均高,应该采用手术加放射的综合治疗;N＋期患者术后应该给予同侧全颈及锁骨上区放疗;手术治疗时未行颈清扫者应行同侧全颈及锁骨上区预防照射。     

Conservation laryngeal surgery for selected pyriform sinus cancer.

AIMS: This study reports the treatment of a cohort of patients with pyriform sinus squamous cell carcinoma, using conservative surgery and radiotherapy. METHODS: Thirty-four patients with pyriform sinus SCC were treated between 1986 and 2001, using partial laryngopharyngectomy with or without complementary radiotherapy. Seventy-six percent had stage III-IV lesions. Quality of life questionnaire and clinical examination were used for evaluation of laryngeal function. RESULTS: Conservation surgery was undertaken. All patients underwent neck dissection. Two thirds of the patients received post-operative radiotherapy. Reconstruction was achieved by local muscular flap in 13 cases, radial forearm free flap in 18 and pectoralis major flap in three. Five-year overall and disease-specific survival rates were 50 and 65%, respectively. Successful laryngeal function preservation with local control was achieved in 80% of the patients. CONCLUSION: Partial laryngopharyngectomy is a suitable treatment for early and selected advanced stage pyriform sinus carcinoma with a good functional and oncologic outcome.     

Survival patterns in patients with carcinoma base of tongue treated with external beam irradiation and salvage surgery

Objective

The current study was designed to assess the treatment results and survival in the patients with carcinoma of base of tongue that were treated with primary radiotherapy, radiotherapy with chemotherapy and salvage surgery when indicated.

Design

A prospective study was carried out in 78 cases of carcinoma of the base of tongue between 1995 and 1999.

Methods

The majority of cases belonged to stage IV 60/78 (76.92%) as per AJCC staging. Radiotherapy in the dose of 60 Gy was given primarily to the patients with stage III tongue base cancer. Patients with early stage IV cancer were given split course radiotherapy followed by assessment for surgery. For the patients with advanced stage IV disease with poor general condition, palliative radiotherapy of 24 Gy with or without palliative chemotherapy was given. 15 patients were subjected to salvage surgery in the form of radical neck dissection alone (8 cases), extended total laryngectomy with neck dissection (3 cases), extended total laryngectomy (2 cases) and extended supraglottic laryngectomy with RND in 2 cases.

Results

Two and 5 years Kaplan — Meier actuarial survival rates were 45% and 10% respectively with local control rates equivalent to survival rates. All surviving patients maintained good function and quality-of-life with few tolerable side effects.

Conclusions

External beam radiotherapy with salvage surgery results in satisfactory local and regional control in stage III and IV carcinoma base of tongue.     

晚期食管鳞癌放疗联合口服替吉奥治疗的疗效

目的:评估口服替吉奥联合三维适形放疗治疗局部晚期食管癌的疗效和安全性.方法:48例局部晚期食管癌患者进入研究,随机分为单纯放疗组(24例)和放疗联合替吉奥化疗组(24例).比较两组患者的疗效、生存时间和不良反应.结果:单纯放疗组客观缓解率62.50%,放化疗联合组客观缓解率91.67%,有显著统计学差异(P<0.05).两组不良反应、生活质量无显著差异.单纯放疗组3年生存率32.33%,放化疗联合组3年生存率61.34%,有显著统计学差异(P<0.05).结论:三维适形放疗同步口服替吉奥化疗治疗晚期食管鳞癌可以有效提高患者的治疗效果,改善预后,不良反应可以耐受,是一种安全有效的治疗方案.     

Advanced squamous cell carcinoma of the larynx

Out of 676 patients with advanced squamous cell carcinoma of the larynx in stage III or IV, 673 patients received primary radiotherapy, either alone or in combination with surgery or chemotherapy. A significantly better survival with loco-regional control was obtained for women than for men. Also, the tumour size was of significant importance, as a better survival with loco-regional control was seen for tumours below 4 cm in largest diameter than for larger tumours. A similar advantage was seen as regards T1 and T2 tumours. There was no difference with regard to the patients' ages, tumour location, node status, or tumour stage III or IV. At 10 years, the crude survival for the total group of stage III and IV patients was 17%, corrected survival 38%.     

Radical radiotherapy for inoperable non-small cell lung cancer: what factors predict prognosis?

We set out to determine the factors that predict the outcome of conventional radical radiotherapy for inoperable non-small cell lung cancer. A retrospective casenote review was carried out of all 69 patients treated between 1986 and 1992 at the Northern Ireland Centre for Clinical Oncology, Belfast, with radical radiotherapy for inoperable non-small cell lung cancer. The tumour dose ranged from 45 Gy to 67.5 Gy, delivered in 15-30 fractions, 5 days per week over 3-6 weeks. All patients were followed up for 5 years. The disease was TNM Stage T1-T4N0-N2M0. The majority of tumours (51) were squamous. Overall survival was 63.8% (44-patients; 95% confidence interval (CT) 51.3-75.2) at one year; median survival was 16 months and 5-year survival was 13% (nine patients; 95% CI 6.1-23.3). Five-year survival for the 36 patients with stage T1 or T2 disease was 5.6% (2 patients). Five-year survival for the 33 patients with stage T3 or T4 disease, all with tumours at or near the carina, was 21.2% (seven patients). A WHO performance status of 0 or 1 (P = 0.03, Cox proportional hazards model) was associated with a better chance of survival.     

肝动脉栓塞加门静脉置泵治疗晚期原发性肝癌(附160例病例分析)

延长晚期原发性肝癌患者的生存时间，提高生活质量，为二期手术切除创造条件。方法：采用肝动脉栓塞化疗加门静脉置泵，术中栓塞药物为：ADM、泛影葡胺、碘化油及MMC；术后门静脉药泵常用ADM、干扰素注射。结果：术后二个月复查B超，肿瘤缩小明显者（缩小至原肿瘤1／3）者74例，占46％，其中18例施行二期肝癌切除术，160例1年后存活率78．6％，2、3、5年存活率分别为65．6％、43．5％及16．3％。结论：采取肝动脉栓塞加门静脉置泵治疗晚期原发性肝癌160例，效果良好，延长了晚期原发性肝癌的生存时间，为二期手术切除创造了条件。     

The treatment of early (T1) glottic and supra-glottic carcinoma: does partial laryngectomy have a place?

A series of 900 patients with laryngeal carcinoma is described. Patients with glottic T1N0 tumours were treated by radiotherapy with a 5-year survival of 92%. Seven per cent of patients suffered recurrence and most were salvaged by surgery: vertical hemilaryngectomy was occasionally useful as a salvage procedure. Patients with supra-glottic T1N0 tumours were treated for the first 7 years by supra-glottic laryngectomy and prophylactic neck dissection and thereafter by radiotherapy. The results were equally good in both series: a 5-year survival of 75-80%. Salvage surgery for failed radiotherapy or surgery for supra-glottic carcinoma gave poor results.     

Occult cervical metastasis of squamous cell carcinoma of tongue among CN0 patients and its treatment

Objective： To explore the treatment of clinically negative neck （CN0） patients with squamous cell carcinoma of the tongue. Methods： 165 CN0 patients with squamous cell carcinoma of the tongue from 1985 to 2002 were investigated retrospectively. Parts of the patients staged at T1, T2 and T3 underwent resection of primary lesion followed by neck observation, and other patients staged above T2 or at T1 but without follow-up were treated with elective neck dissection （END）. All patients were followed up for more than 3 y or until their death. Results： Lymphatic metastasis was identified histologically after operation in 33 of 120 patients treated with END, and 9 of 45 patients treated with resection of primary lesion alone. The overall rate of occult lymphatic metastasis was 25.45%, which increased with the elevating of clinical T stage. The overall rate of neck uncontrolled death was 20.00% for observation group and 5.00% for END group, and significant difference was found between them （P〈0.05）. For T~ patients in the two groups, the rate of neck uncontrolled death was 7.71% and 4.00% respectively, and no significance was found between them （P〉0.05）. When stage T2 and T3 were considered as middle stage together, significant difference （P〈0.05） could be obtained between observation （70.00%） and END group （0%）. Conclusion： The occult metastasis rate of squamous cell carcinoma of tongue increases with the elevating of clinical stage, and elective neck dissection could be considered for NO patients staged over T2 to improve neck control and survival rate; and regional resection alone of primary lesion could be considered for T1N0 patients to improve quality of life if closely followed up is conducted.     

Clinicopathologic significance of bcl-2 expression in the surgical treatment of oral tongue carcinoma.

AIM: There is still controversy on the incidence of positive expression of bcl-2 and its prognostic significance for oral tongue carcinoma patients who are treated by surgery. The present study aims at resolving the controversy on the clinicopathologic significance of bcl-2 in a well selected group of patients who satisfy the recruitment criteria: (1) oral tongue carcinoma, (2) squamous cell carcinoma, (3) primary surgical treatment.METHOD: Bcl-2 expression was studied by immunohistochemistry on glossectomy specimens of 73 patients. The expression of bcl-2 was correlated with clinicopathologic data.RESULTS: Of the 73 tumours, 11% had positive expression of bcl-2. Bcl-2 expression was not significantly correlated with tumour grade, stage, nodal metastasis and survival.CONCLUSION: Bcl-2 expression played a minor role in oral tongue carcinoma. It had no significant correlation with tumour grade, stage and nodal metastasis. It also had no prognostic value on survival for patients who were treated by primary surgery.     

Carcinomas of the nasopharynx in adults

From 1959 through 1980, 139 MO adult patients (greater than 15 Y.) presenting with nasopharyngeal cancer were treated by definitive radiotherapy: 103 (74%) undifferentiated carcinomas and 36 (26%) squamous cell carcinomas. Chemotherapy was prescribed only in case of failure of treatment. Case distribution is the following according to UICC classification: stages I and II: 12%, stage III: 16%, stage IV: 72%. Survival rate is respectively 70%, 45%, 20%. The overall 3 and 5 year survival rate is 46% and 30%. Almost 80% of the failures occur by the end of the second year. Local control is 95% for T1-T2, 73% for T3 and around 50% for T4 cases. Isolated node failure occurs in 2% and distant metastases in 30%.     

Predictive factors of occult metastasis and prognosis of clinical stages I and II squamous cell carcinoma of the tongue and floor of the mouth

The incidence of occult neck metastasis in early stage tumours of the tongue and floor of the mouth varies from 20% to 30%, and the survival rates in 5 years from 73% to 97%. This study analyzes the rates of occult metastasis and prognostic factors for clinical stages I and II squamous cell carcinoma of the tongue and floor of the mouth. The records of patients with squamous cell carcinoma of the tongue and floor of the mouth, without prior treatment and treated by surgery between 1965 and 1998 were reviewed. All cases were re-staged and the surgical specimens were reviewed. This study included 193 patients, 145 men (75.1%), with ages ranging from 29 to 89 years old (mean, 60 years). The tumour site was the tongue in 132 cases (68.4%), the floor of the mouth in 45 (23.3%) and both in 16 (8.3%). With regard to stage, 85 cases were at clinical stage I (44.0%) and 108, clinical stage II (56.0%). One hundred and seventeen patients (60.6%) were submitted to a neck dissection and 27 (23.1%) had metastasic lymph nodes (pN+). The only factor associated with the presence of occult metastasis for all patients was the presence of muscular infiltration (p = 0.020); for tongue tumours the presence of vascular embolization (p = 0.043) and the presence of desmoplastic reaction (p = 0.050); for floor of the mouth tumours and T2 tumors, the histological grade (p = 0.025 and p = 0.035, respectively). Disease-free survival in 5 years was 66.4% and overall survival in 5 years 68.5%. The only factor associated with disease-free survival was the presence of muscular infiltration (p = 0.019) and with overall survival were gender (p = 0.002) and clinical stage (p = 0.031). Tumours of the tongue and floor of the mouth in the initial stages, which had muscular infiltration showed a higher probability of occult metastasis and lower disease-free survival; T2 tumours showed a worse survival as did patients of the male gender.     

Long-term functional outcome of brachytherapy for carcinoma of the mobile tongue: focus on the atrophic change of irradiated tongue

OBJECTIVE: To assess tongue atrophy and long-term functional outcome of mobile tongue cancer patients after interstitial radiotherapy. METHODS: Of 493 patients whose squamous cell carcinoma of the mobile tongue had been treated with low dose rate brachytherapy, there were 57 patients evaluated between July 2002 and April 2004 whose tongue had not been modified by surgical procedures and who had no primary recurrence. The median time from treatment to evaluation was 96 months (range: 9-214 months). Almost all of the patients belonged to the early stage tongue cancer (T1/T2/T3/T4=30:24:3:0), and all had received interstitial radiotherapy with a single-plane implant. To evaluate the deformity of the tongue, we used a grading system that classified the atrophic changes of the tongue into four categories (G0-G3). RESULTS: Thirty-nine patients (70%) showed mild tongue hemiatrophy (G1 or G2) in the irradiated side. However, no patients showed severe atrophy where the tongue cannot be made to protrude beyond the incisors (G3). The length of time after brachytherapy was >72 months and the age of the patients at brachytherapy had the same statistical significance (P=0.0366). As for functional outcome, understandability of speech and a normal diet were preserved for almost all patients. CONCLUSION: The progression of atrophic change in the irradiated tongue occurred over a long term after brachytherapy. However, most patients could maintain their activities of daily life without severe restriction.     

Soft tissue sarcomas of the lower extremity: surgical treatment and outcome.

AIMS: The aims of this retrospective follow-up study were to evaluate the justification for limb-saving multi-disciplinary treatment of soft tissue sarcomas (STS) and to report the results achieved by our treatment protocol. Local control was studied, with emphasis on tumour depth, operation margin and need for post-operative radiotherapy. METHODS: We examined 130 patients with STS in the lower limb referred to the multi-disciplinary group of Helsinki University Central Hospital. For the survival analysis 106 patients with local disease remained. The goal of treatment was to preserve a functional limb. Wide excision was attempted. If the margin was less than 2.5 cm, post-operative radiotherapy (RT) was delivered to all except 20 patients. RESULTS: Ninety-two per cent of the patients were treated by limb salvage. The success rate of free flaps was 16 out of 18. The 5-year disease-specific overall survival was 76%, metastasis-free survival 72% and local control 79%. Prognostic factors for local recurrence were extracompartmental site and large size; for development of metastases high grade, extracompartmental site and large size; for decreased disease-specific overall survival high grade, large size and advanced age. Local control of intramuscular tumours (n=6) was 100%, subcutaneous tumours (n=38) 94% and tumours penetrating the deep or muscle fascia and those locating extracompartmentally (n=62) 67%. CONCLUSIONS: Limb salvage in patients with STS is possible with an acceptable outcome by selective combination of treatment modalities. Modern plastic surgical methods with free tissue transfers are successful and often needed. Subcutaneous and intramuscular tumours have good local control. The outcome is poorest for tumours penetrating the deep or muscle fascia and for those located extracompartmentally, and patients with such tumours might be a target for adjuvant therapy. Treatment should be coordinated by multidisciplinary teams.     

诱导化疗对舌鳞癌患者远期疗效的影响

背景与目的：诱导化疗在舌鳞癌综合治疗中有重要作用,但它对患者远期疗效的影响还不明确,本文旨在探讨诱导化疗后原发灶组织病理学阴性与舌鳞癌患者远期疗效的关系。方法：回顾性分析25例舌鳞癌诱导化疗后原发灶组织病理学阴性患者的3、5年生存率,无瘤生存率及其治疗失败原因。结果：原发灶组织病理学阴性患者3、5年生存率（91.75%,91.66%)均比有肿瘤残留者（64.52%,57.00%)高,其无瘤生存率也比有肿瘤残留者高,治疗失败原因主要为局部复发和/或区域淋巴结转移/复发。结论：诱导化疗可提高原发灶组织病理学阴性舌鳞癌患者的远期生存率。