晚期贲门癌根治性放疗与手术治疗的比较

目的分析比较晚期贲门癌根治性放疗（ＤＴ６０～７０Ｇｙ，６～７周）与手术治疗的疗效。材料与方法１９８５年１月至１９８８年１月间将８２例晚期贲门癌患者随机分为放疗组和手术组进行对比治疗。放疗组４０例，手术组４２例，（手术切除３０例、探查术１２例），放疗剂量ＤＴ６０～７０Ｇｙ，６～７周。结果放射治疗后梗阻症状改善率为９０％，Ｘ线好转率８０％。放疗组与手术切除组１，３，５年生存率分别为８２．５％和６０．０％（Ｐ＜０．０５），２２．５％和０（Ｐ＜０．００１），５％和０（Ｐ＞０．０５），探查组无１例生存１年以上。结论放疗组的疗效明显优于手术组，根治性放射治疗是晚期贲门癌的重要治疗手段。     

宫颈癌合并宫腔积液的放疗疗效分析

自１９８０年１月至１９９０年１２月，对１８９９例宫颈癌患者行单纯放射治疗，其中合并宫腔积液者１７１例，宫腔积液的发生与患者年龄、子宫位置及腔内治疗方法有关（Ｐ值分别＜０．０１、＜０．０１和＜０．０５）而与肿瘤的分期、病变类型及病理类型无关；合并宫腔积液者放疗后５ａ生存率低于对照组（Ｐ＜０．０５），其中放疗结束后宫腔积液持续存在、宫体大小超过孕６周、血性积液及积液量多于５０ｍｌ者的５ａ生存率明显低于无积液组（Ｐ值分别＜０．０１、＜０．０１、＜０．０５及＜０．０５），对有上述情况的患者，要高度警惕宫体受侵，必要时要增大Ａ点放疗剂量或行子宫切除以改善预后     

原发性输卵管癌的治疗（附21例分析）

本文通过回顾性总结，探讨原发性输卵管癌的治疗问题。本组２１例患者，五年生存率４０％（６／１５）。三年生存率５７．１％（１２／２１）。２１例中１９８６年前治疗５例，术后辅以放射治疗为主，生存时间８月－６４月，平均２８．５月。１９８６年以后治疗１６例，术后主要辅以顺铂等药物的联合化疗，生存时间１１月－８４月，平均４８月（Ｐ＜０．０５）。根据术后残存肿瘤直径＜１ｃｍ和＞１ｃｍ分成两组，两组平均生存时间分别为５２．５月和２７月（Ｐ＜０．０１）。我们认为：首次彻底手术，术后辅以顺铂为主的联合化疗，部分病例加放射治疗效果较好。     

超长食管癌215例临床分析

目的回顾性分析超长食管癌不同方法治疗后的疗效，探讨超长食管癌的治疗对策。方法对１９８７年３月至１９９２年８月间２１５例超长食管癌单纯外放射治疗、外放射＋腔内放疗、单纯手术治疗、术后放疗和术前放疗患者的生存率采用ｋａｐｌａｎ－Ｍｅｉｅｒ分析、ｌｏｇ－ｒａｎｋ检验，其它结果采用卡方检验，探讨不同治疗方法的疗效及失败的原因。结果超长食管癌术后放疗和术前放疗疗效较好，术前放疗不增加手术并发症，能明显降低“Ｔ”分期（Ｐ＜０．０５）；姑息术后放疗能明显提高５年生存率（Ｐ＜０．０５），根治术后放疗组５年生存率比单纯手术组提高１５．１％，术后放疗能明显降低淋巴结转移率（Ｐ＜０．０５）；超长食管癌失败的主要原因为局部未控或复发和远处转移，外放射＋腔内放疗有降低局部未控或复发率的趋势。结论对超长食管癌应采用手术＋放疗进行综合治疗，不能手术治疗者应采用非常规分割外放射配合腔内放疗和全身化疗。     

卡铂加放疗联合治疗中晚期食管癌

目的比较卡铂合并放疗与单纯放疗治疗中晚期食管癌的疗效及毒副作用。方法１９９０年８月～１９９２年１０月收治１９２例经病理证实为鳞癌的食管癌病人。病变长度为５－１０ｃｍ,随机配对分为两组,卡铂合并放疗组（卡铂组）与单纯放疗组（单放组）。结果卡铂合并放疗组近期疗效明显优于单纯放疗（Ｐ＜０．０５）。１、３、５年生存率,卡铂组分别为６１．５％、３０．２％、２５．０％;而单放组则为４１．７％（Ｐ＜０．０１）、２０．８％（Ｐ＞０．０５）、１６．７％（Ｐ＞０．０５）。毒副作用为轻度造血功能抑制与放射性食管炎。对症处理后不影响疗程。结论卡铂配合放疗治疗食管癌有协同作用。其毒副作用小,临床应用安全可行。     

喉癌的放射治疗（附323例10年疗效分析）

本文分析了１９６４－１９８２年３２３例喉癌的放射治疗结果，全组病例的１，３，５，１０年生存率发别为７３．９％，５０．８％，４６．７％和２７．９％。声门上区癌的５年生存率为４４．２％，声门区癌为４９．１％，声门下区癌为０％。重点讨论了影响疗效的有关因素，如放疗适应症，照射剂量，投照技术和放射与手术综合治疗等问题。     

194例超长食管癌不同治疗方法疗效分析

目的回顾性分析超长食管癌＞８ｃｍ不同治疗方法治疗后的疗效，探讨超长食管癌的治疗对策。材料与方法对１９８７年３月至１９９２年３月间１９４例超长食管癌单纯外放射治疗、外放射＋腔内放疗、单纯手术治疗、术后放疗和未治疗的患者的生存率采用Ｋａｐｌａｎ－Ｍｅｉｅｒ分析，Ｌｏｇ－ｒａｎｋ检验，其它结果采用χ２检验，探讨不同治疗方法的疗效及失败原因。结果超长食管癌术后放疗疗效最好，姑息术后放疗能明显提高５年生存率（Ｐ＜０．０５），根治术后放疗５年生存率比单纯手术提高１５．１％，术后放疗能明显降低淋巴结的转移率（Ｐ＜０．０５）。超长食管癌失败的主要原因为局部未控或复发和远处转移，外放射＋腔内放疗有降低局部未控或复发的趋势。结论对超长食管癌的治疗应采取积极的治疗措施，能够手术治疗的应尽可能地根治性切除，术后均应作放射治疗；不能手术治疗者应采用非常规分割外放射配合腔内放疗和全身化疗。     

111例食管癌锁骨上淋巴结转移放射治疗疗效分析

目的　探讨食管癌锁骨上淋巴结转移放射治疗的价值及影响预后因素。方法　１９８４ 年９ 月至１９９２ 年１２ 月收治食管癌锁骨上淋巴结转移１１１ 例,均采用６０Ｃｏ 外照射,食管ＤＴ６０ ～７０Ｇｙ,锁骨上ＤＴ５０～６６Ｇｙ。结果　治疗后的１、３ 、５ 年生存率分别为４９．６ ％ 、１０．８％ 、６．３ ％ ;病变长度≤５．０ ｃｍ 、５．１ ～８ ｃｍ 、＞ ８ ｃｍ 的５ 年生存率分别为１５％ 、２．５ ％ 、０（ Ｐ＜０．０５） ;疗终Ｘ线表现基本消失与部分消失的５ 年生存率分别为１２．５％ 、１．８％（ Ｐ＜ ０．０５）;锁骨上淋巴结＜３ ｃｍ 和≥３ ｃｍ 的５ 年生存率分别为８．１ ％ 、０ 。结论　食管癌锁骨上淋巴结转移应积极治疗,淋巴结大小、食管病灶长度、疗终Ｘ线表现、放疗剂量是影响预后的主要因素     

体外加腔内照射与单纯外照射治疗宫颈癌的远期疗效观察

 目的分析体外加腔内照射（Ａ组）与单纯外照射（Ｂ组）治疗宫颈癌的远期疗效。方法　外照射加１９２Ｉｒ高剂量率后装腔内放疗治疗宫颈癌４５例，并与同期单纯外照射宫颈癌４５例进行比较。结果　Ⅱ期Ａ组和Ｂ组５年生存率分别为９０％　和６３．６％（Ｐ＜０．０５），局部复发率分别为２０％和５０％（Ｐ＜０．０５）；Ⅲ期Ａ组和Ｂ组５年生存率分别为６８％　和４３．５　％　（Ｐ＜０．０５），局部复发率分别为２８％　和６５．２％（Ｐ＜０．０１）。鳞癌和腺癌的５年生存率分别为６７．９％和３３．３％（Ｐ＜０．０５）。结论宫颈癌的５年生存率及局部控制率体外加腔内放射治疗明显优于单纯外照射，鳞癌优于腺癌。     

中晚期食管癌155例治疗分析

为探讨中晚期食管癌单纯手术和放疗以及综合治疗疗效，回顾分析了１９９２年７月至１９９７年１２月间收治的中晚期食管癌１５５例临床资料，其中单纯手术２８例，单纯放疗５８例，术后放化疗５３例，放化疗１６例。放疗剂量６５～７０Ｇｙ。采用ＰＦＢ（ＤＤＰ＋５Ｆｕ＋ＢＬＭ）方案治疗。结果显示１ａ，３ａ，５ａ生存率分别为６０．０％，３４．２％和２０．６％。术后放化组５ａ生存率（２８．３％）比单纯手术组（２１．４％）高，放化组５ａ生存率（２５．０％）比单纯放疗组（１２．１％）高，但２组均无显著性差异（Ｐ＞０．０５），结果提示中晚期食管癌术后辅以放化疗可减少和延缓肿瘤复发和转移，放疗和化疗对治疗局部复发和远处转移有一定疗效。     

Randomized study of local control and survival following radical surgery or radiation therapy in oral and laryngeal carcinomas.

From 1971 to 1975, 100 patients with glottic, supraglottic, and oral cavity lesions were prospectively randomized between primary radiation treatment and primary surgery. Local control and survival were similar with either treatment for lesions of the oral cavity or supraglottic larynx. Comparison between radiation alone and surgery alone for T1 and T2 glottic laryngeal lesions showed local control rates of 76% and 100% (P=0.32); after secondary salvage attempts, local control rates were 82% and 100%, respectively (P= 0.52). Neither result approached statistical significance. Successful radiation for early glottic larynx lesions resulted in superior deglutition and equivalent voice function compared to successful primary treatment with conservation laryngectomy. For oral cavity lesions, swallowing was impaired in the same percentage of radiated and operated patients, but fewer primary radiation patients had articulation difficulties. Among the patients with supraglottic larynx lesions, aspiration was not a problem with either radiation or surgery, but successful radiation perhaps maintained a slightly better voice quality.     

Glottic and supraglottic carcinoma: a retrospective comparison of radiotherapy alone with sandwich therapy in 366 patients

From 1971 through 1982, 442 patients with laryngeal carcinoma were seen at the Leiden University Hospital. They were treated either with radiotherapy alone, sandwich therapy (pre- and postoperative radiotherapy) or by surgery followed by postoperative irradiation. Three hundred and sixty-six patients with glottic or supraglottic tumours could be analysed with respect to two different treatments, complications of treatment and some prognostic factors. Two endpoints of analysis were used: disease-free interval and survival to cancer death. In patients with glottic or supraglottic carcinoma, the survival of patients with advanced disease, treated with radiotherapy only, was worse as compared to the survival of the same category of patients who were treated with sandwich therapy (p less than 0.005). In patients with small glottic tumours, radiotherapy alone was mostly used. In small supraglottic tumours, the survival with both therapy policies was equal. Persistent hoarseness in patients with small glottic tumours, treated with radiotherapy only, is of predictive value for the development of a recurrence (p less than 0.001). There was no influence on prognosis of histological differentiation of the tumour. It appeared that interruption of radiotherapy for more than two days had an adverse effect on survival in patients with glottic carcinoma (p = 0.0001). Finally, the occurrence of second malignancies was analysed. It was found that 19% had a second malignancy. Almost 60% of them were lung cancers.     

The Patterns of Care Outcome Studies: results of the National practice in carcinoma of the larynx

The Patterns of Care Study conducted a survey of patients with glottic and supraglottic carcinomas treated in 1973 and 1974. Patients for this study were randomly selected from all types of treatment facilities, including those with full and part-time therapists and large and small institutions. Detailed evaluation and treatment parameters were recorded for a total of 707 patients. Overall three-year recurrence free survival for glottic carcinoma was: Stage I, 90%; Stage II, 78%; Stage III, 65%; and Stage IV, 23%. For supraglottic carcinoma the rates are: Stage I 78%, Stage II, 60%, Stage III, 34% and Stage IV, 30%. The use of surgery in this study for advanced lesions varied among different departments. For advanced lesions, those treated with combined radiation and surgery had improved survival; this was also related to completeness of work-up and departmental equipment.     

局部晚期喉鳞癌cN0临床观察

目的：探讨喉癌cN0患者颈部处理的方法，降低颈淋巴结转移癌的复发率。方法：回顾分析87例T3、T4期cNo喉癌患者的临床资料，颈部处理方式为颈改良性清扫术或颈分区清扫术，分析手术组阳性淋巴结的分布情况及病理特点，观察颈清扫术对预后的影响，采用Kaplan—Meier方法计算肿瘤复发及生存趋势。结果：87例颈部淋巴结隐性转移率为36．8％，声门上型喉癌40．4％，声门型喉癌32．5％；淋巴结转移分布为：声门上型喉癌89．5％（17／19）位于Ⅱ和Ⅲ区，声门型喉癌92．3％（12／13）位于Ⅱ和Ⅲ区；5年颈部复发率：隐性淋巴结转移复发率为13．5％，无隐性淋巴结转移复发率6．7％；5年生存率：有淋巴结隐性转移生存率为53．8％，无隐性转移为71．1％。结论：晚期喉癌隐性转移率较高，分区清扫术后，隐性转移复发率与无隐性转移复发率无差别，分区清扫术十分必要，注意双侧Ⅱ、Ⅲ区的淋巴结清扫。     

喉鳞癌全喉与喉部分切除术的远期疗效分析

目的　回顾分析声门上型及声门型喉鳞癌患者经全喉及喉部分切除治疗后的远期效果 ,提出今后治疗措施。方法　 42 3例喉癌患者中 ,声门上型 32 7例 ,声门型 96例。 2 43例全喉切除患者中 ,声门上型喉癌 2 10例 ,声门型 33例。喉部分切除的 180例中 ,声门上型 117例 ,声门型 6 3例。依照直接法计算出声门上型和声门型喉癌的全喉切除与喉部分切除的 1,3,5年生存率 ,以及各期病例的 3,5年生存率。结果　 32 7例声门上型喉癌术后 5年生存率为 72 9% ,全喉与喉部分切除的 5年生存率分别为 70 1%和 77 4% (P >0 0 5 )。 96例声门型喉癌术后 5年生存率为 86 0 % ,其中全喉与喉部分切除后的 5年生存率分别为 72 2 %和 92 3% (P <0 0 5 )。结论　喉癌治疗仍以手术为主 ,声门上型喉癌的喉部分切除与全喉切除远期疗效大致相等 ,而声门型喉癌的喉部分切除远期疗效明显高于全喉切除。在适应证选择合适的基础上 ,应大力倡导开展有利于患者生存质量的喉部分切除手术。     

A Consecutive Series of Patients with Laryngeal Carcinoma Treated by Primary Irradiation

In Denmark there is an increasing frequency of laryngeal carcinoma, in particular in women and among these especially in supraglottic tumours. The incidence during the past 20 years has risen from about 40 to 60 cases per million per year. A series of 335 consecutive patients treated with primary radiation is presented. In one-third of all patients the tumour was localized in the supraglottic area; in women in more than half and in men in about one-fourth of the cases. The frequency of primary lymph node metastases in the supraglottic and the glottic tumours was 24% and 2% respectively. A multivariate analysis identified sex and tumour size as independent prognostic parameters of local control. Five-year survival corrected for intercurrent deaths was obtained in 59% of all cases, in 56% of supraglottic and in 92% of glottic tumours. A multivariate analysis defined localization, tumour grade and stage as independent prognostic parameters of survival. Salvage surgery was performed in about 32% of the cases, total laryngectomy in 26%, and partial laryngectomy in 6%. The survival rate among all total laryngectomies was 55%. A tracheostomy during or before radiation treatment prior to total laryngectomy had no influence on complication rate, admission time or recurrence rate. The frequency of pharyngo-cutaneous fistulae in the entire series was 11.5%; after routine use of metronidazol, however, only 5.7%. Radical neck dissection was carried out in 7.8% of the cases, by far most in the supraglottic group, only a few in the glottic carcinomas, in three-fourth in connection with a laryngectomy and in one-fourth without local recurrence in the larynx.     

Carcinoma of the endolarynx: results of irradiation.

Irradiation at the University of Michgan in the 1960's was carried out in 192patients with endolaryngeal carcinoma. Thirty-two and 66% of the cases were located inthe supreaglottic and glottic regions respectively. Cases were classified in stages appropiate TNM GROUPING. Results were analyzed with respect to tumor location, size, anddose-time relationship. Early lesions were controlled more often than advanced ones. Radical surgery to the primary and/or neck improved overall survival, which was 89% at 5years for 127 glottic carcinoma cases and 61% for 61 patients with supraglottic tumors. No significant complications were found following radiation therapy.     

Early laryngeal cancer

Opinion statement For early-stage laryngeal cancer, both surgery and radiotherapy are effective treatment modalities, offering a high rate of local control and cure for this select group of patients. The probability of obtaining local control for early glottic cancer is similar when comparing the results of radiation therapy, cordectomy, and hemilaryngectomy. Radiation therapy has been the treatment of choice for all previously untreated T1 and T2 vocal cord cancers at our institution. We currently treat most patients with irradiation and consider transoral laser excision for the small subset of patients with welldefined T1 tumors that are limited to the mid-third of the cord. In this area, excision will not significantly diminish voice quality. Stage I and stage II supraglottic cancers may be treated with either radiation therapy alone or with a supraglottic laryngectomy with bilateral selective neck dissections (levels II-IV). In experienced hands, transoral laser excision also is an acceptable alternative for selected lesions. Overall, approximately 80% of patients at our institution are treated initially by irradiation.     

T3声门型喉鳞状细胞癌手术治疗效果及影响因素分析北大核心

目的:探讨T_(3)声门型喉癌患者行全喉切除术或部分喉切除术的临床效果及影响因素。方法:回顾性分析手术治疗的84例T_(3)声门型喉鳞状细胞癌患者的临床资料,包括性别、年龄、病理学分级、N分期、手术方式、手术切缘、术后放疗、术后咽喉部复发、术后颈部淋巴结复发,评估与喉癌预后的相关性;生存分析采用Kaplan-Meier法计算,单因素分析采用Log-rank检验或者χ^(2)检验,多因素分析采用Cox比例风险回归模型。结果:T_(3)声门型喉癌患者5年总体生存率为75.0%,10年总体生存率为64.7%;部分喉切除术患者5年生存率79.6%,全喉切除术患者5年生存率68.6%;单因素分析显示年龄、病理学分级、手术切缘、N分期、术后咽喉部复发、术后颈部淋巴结复发与T_(3)声门型喉癌的预后相关(P<0.05);多因素分析显示年龄、N分期、手术切缘、肿瘤复发是影响T_(3)声门型喉癌患者生存的独立危险因素(P<0.05)。结论:对于选择的T_(3)声门型喉癌患者,部分喉切除术在保留喉功能的同时可获得较好的肿瘤学效果;精确评估肿瘤范围,保证安全切缘,合理的颈清扫术及术后及时放疗可以提高患者的生存率。     

Planned preoperative radiation therapy for advanced laryngeal carcinoma

One hundred ten patients with predominantly advanced laryngeal carcinoma were treated in the period 1969–1978 with planned preoperative radiation therapy followed by surgery. Site distribution was: 63 supraglottic, 26 glottic, 15 transglottic and 6 subglottic. There were 4 Stage II patients, 66 Stage III and 40 Stage IV. Preoperative radiation therapy consisted of Telecobalt irradiation to a total dose of 25 Gy given to a target volume encompassing the larynx and regional neck nodes, given in 5 equal daily fractions of 5 Gy in 5 consecutive days. Surgery was performed 2 days later. Total laryngectomy was performed on 48 patients, total laryngectomy with neck dissection on 55 patients, supraglottic laryngectomy on 5 and supraglottic laryngectomy with neck dissection on 2 patients. Crude actuarial 5 and 10 year survival probability for the whole group is 71 and 61%, respectively. The corrected 5 and 10 year survival is 75%. For patients with T₃T₄N₀ tumors 5 and 10 year survival probability is: crude 65 and 58%, and corrected 70% respectively. For T₃T₄N , crude: 75 and 60% and corrected: 78%.Of 110 patients, one died postoperative, three died of intercurrent disease, five died as a result of second malignancy, and 23 died of their larynx carcinoma: $\text{12}\text{23}$ because of locoregional failure, and $\text{11}\text{23}$ because of distant metastasis. We concluded that short intensive preoperative radiation therapy and surgery offer a high cure rate in the treatment of advanced resectable laryngeal carcinoma. The merits of this technique are outlined in the text.