Radiotherapy and verrucous carcinoma of the oral cavity. A study of 107 cases.

One hundred and seven cases of oral verrucous carcinoma treated primarily with radiotherapy at Kasturba Hospital, Manipal, India between 1977 and 1987 were analysed concerning location within the oral cavity, clinical extent, and effectiveness of radiotherapy. The most common site was the buccal mucosa followed by the buccogingival sulcus. Only 13.2% of the patients presented with T1 or T2 tumours and 32.7% had clinically negative nodes. Biopsy had to be repeated more than once in 22 patients to get confirmation of invasive carcinoma. The 5-year survival rate was 35% for stage III and 26% for stage IV. The treatment results with radiotherapy were comparable with those for ordinary squamous cell carcinoma of the oral cavity. It is felt that the treatment policy for verrucous carcinoma can be the same as for ordinary squamous cell carcinoma. In order to prevent delay in diagnosis and treatment, proper cooperation between the treating oncologist and the pathologist is essential.     

Elective neck irradiation in the treatment of cancer of the oral tongue

A total of 69 patients with squamous cell carcinoma of the oral tongue Stages T1-2-3 N0 were treated between 1952 and 1982 at one cancer center in Montevideo, Uruguay. Of 52 patients with the primary disease controlled, 2 had elective cervical lymph node dissection, and were therefore excluded from the study, 25 were treated with elective neck irradiation, and 25 were followed without irradiation to the neck. In the untreated group, 40% developed neck node metastases, while this was observed only in 20% of the group receiving elective neck irradiation, but only 4% recurred in the elective irradiated areas of the neck (p: 0.0028). The survival was the same for each group (5-year absolute survival with NED 67% for the neck irradiation group and 64% for the unirradiated group). From this retrospective study, we conclude that elective neck irradiation in carcinoma of the oral tongue decreases the incidence of neck metastases but an improvement in survival of these patients was not demonstrated.     

Carcinoma of the hard palate treated with radiotherapy: a retrospective review of 31 cases.

There are few studies reporting the results of radical radiotherapy for carcinoma of the hard palate. We have examined our results of patients treated within a single institution, and assessed survival, local control and morbidity. A retrospective analysis was made on 31 patients with hard palate carcinoma treated with external beam radiotherapy at the Christie Hospital between 1990 and 1997. Twenty-six patients received radiotherapy alone and five were treated for post-operative positive surgical margins. The 5-year actuarial survival rate was 55%. The actuarial 5-year local control rate was 53%, rising up to 69% after salvage surgery. Survival was 48% for squamous cell carcinomas and 63% for salivary gland carcinomas, the difference was not significant. The only significant predictor of local control was T-stage, with 80% 5-year local control of T1-2 lesions and 24% control of T3-4 lesions. N-stage was the only significant factor predicting for survival. Radiation necrosis occurred in one patient. Radical radiotherapy for carcinoma of the hard palate is safe and well tolerated. It is an effective treatment for both squamous cell carcinoma and salivary gland carcinoma.     

舌体癌121例治疗结果分析

目的回顾性分析比较手术治疗和放射治疗对舌体癌远期疗效的影响以及相关因素.方法1987年3月至1995年6月收治的121例舌体鳞癌接受了根治性治疗.25例采用根治性体外放射治疗(R),62例为联合根治手术治疗(S),34例为联合根治手术加术后放射治疗(S+R).用Kaplan-Meier方法分析疗后生存率及局控率.结果全组病例总的5年总生存率为46.40%,三组病例的5年总生存率分别为R组28.88%、S组42.05%和S+R组65.56%,具有显著性差异(P=0.0051).结论联合根治术加术后放射治疗对于舌体癌是一种较为有效的治疗手段.术后放射治疗可以提高手术治疗的局部控制率和远期生存率.     

局部放疗对Ⅳ期食管鳞癌患者生存影响的回顾性分析

目的:探讨局部根治剂量及姑息剂量放疗对Ⅳ期食管鳞癌患者生存的影响。方法:回顾性分析2010年1月至2016年7月我院初治的36例Ⅳ期食管鳞癌患者的总体生存时间、1年、2年及3年生存率，同时比较化疗后根治剂量放疗及姑息剂量放疗对生存时间、局部有效率和不良反应的影响。结果:36例Ⅳ期食管鳞癌患者的1年、2年、3年生存率分别为66.7%、36.1%和19.4%，总体中位生存时间为13.5个月。高剂量放疗组和低剂量放疗组的中位生存时间分别是17个月和11个月，1年、2年、3年生存率分别是81%、42.9%、28.6%和46.7%、20%、6.7%，二者的中位生存时间有统计学差异（P=0.024）。高剂量放疗组和低剂量放疗组的放疗有效率分别为71.4%和26.7%，二者之间有统计学差异（P=0.017）。两组间的白细胞减少和血小板减少程度无统计学差异（P>0.05），放射性食管炎及放射性肺炎发生率也无统计学差异（P>0.05）。结论:化疗后给予Ⅳ期食管癌患者局部病灶根治性放疗，有改善患者总体生存的趋势。     

Laryngeal carcinoma in patients 40 years of age and younger

Between 1950 and 1985, 570 patients with squamous cell carcinoma of the larynx were diagnosed and treated in the Otolaryngology Department of the Beilinson Medical Center. Of these, 20 patients (2.8%) were aged 40 years or younger. Twelve patients (60%) had glottic carcinoma in Stage I (T1N0M0) when initially diagnosed, one patient had supraglottic carcinoma in Stage I (T1N0M0) and seven patients (35%) had laryngeal carcinoma in Stage II (T2N0M0) and III (T3N0M0). Patients with T1N0M0 received only radiotherapy. Three patients with T2N0M0 underwent total laryngectomy and also received postoperative radiotherapy. Four patients with the tumor in T3N0M0 received pre-operative and postoperative radiotherapy in addition to total laryngectomy. The 5-year survival rate for T1N0M0 and T2N0M0 was 100% and for T3N0M0 66%. Although a high percentage of the young patients presented for treatment with advanced disease, the survival rate compared the same or favorably with rates in older patients. This supports the concept of aggressive treatment when there is a recurrence or second primary, particularly because it is well tolerated in the young age group who do not exhibit many of the conventional risk factors and therefore, have a better prognosis.     

Treatment and prognosis of squamous cell carcinoma of the external auditory canal and middle ear: a multi-institutional retrospective review of 87 patients

PURPOSE: To examine the relative roles of surgery, radiotherapy, and chemotherapy in the management of patients with squamous cell carcinomas of the external auditory canal and middle ear. METHODS AND MATERIALS: The records of 87 patients with histologically confirmed squamous cell carcinoma who were treated between 1984 and 2005 were reviewed. Fifty-three patients (61%) were treated with surgery and radiotherapy (S + RT group) and the remaining 34 patients with radiotherapy alone (RT group). Chemotherapy was administered in 34 patients (39%). RESULTS: The 5-year actuarial overall and disease-free survival (DFS) rates for all patients were 55% and 54%, respectively. On univariate analysis, T stage (Stell's classification), treatment modality, and Karnofsky performance status had significant impact on DFS. On multivariate analysis, T stage and treatment modality were significant prognostic factors. Chemotherapy did not influence DFS. The 5-year DFS rate in T1, T2, and T3 patients was 83%, 45%, and 0 in the RT group (p < 0.0001) and 75%, 75%, and 46% in the S + RT group (p = 0.13), respectively. The 5-year DFS rate in patients with negative surgical margins, those with positive margins, and those with macroscopic residual disease was 83%, 55%, and 38%, respectively (p = 0.007). CONCLUSIONS: Radical radiotherapy is the treatment of choice for early-stage (T1) diseases, whereas surgery (negative surgical margins if possible) with radiotherapy is recommended as the standard care for advanced (T2-3) disease. Further clarification on the role of chemotherapy is necessary.     

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。     

老年舌鳞状细胞癌的手术治疗及放射治疗疗效分析

目的分析不同治疗方法治疗老年(≥60岁)舌鳞状细胞癌的疗效。方法对1993年3月至2006年5月期间收治的31例老年舌鳞状细胞癌患者进行回顾性分析,比较单纯手术、单纯治疗、术前放疗和术后放疗对舌鳞状细胞癌患者5年生存率和复发率的影响。结果单纯手术组、单纯放疗组、术前放疗组、术后治疗组的Ⅰ^Ⅱ期老年舌鳞状细胞癌患者的5年累积生存率分别为87.5%、73.9%、80.0%和83.3%(P=0.206),复发率分别为31.2%、42.3%、29.3%和26.4%(P=0.132);ⅢⅡ期老年舌鳞状细胞癌患者的5年累积生存率分别为87.5%、73.9%、80.0%和83.3%(P=0.206),复发率分别为31.2%、42.3%、29.3%和26.4%(P=0.132);Ⅲ^Ⅳ期患者的5年累积生存率分别为62.5%、17.4%、60.8%和62.7%(P=0.012),复发率分别为63.8%、92.3%、50.1%和61.3%(P<0.001)。结论老年早期舌鳞状细胞癌患者可采用单纯手术治疗,晚期舌鳞状细胞癌的治疗宜采用手术联合放射治疗。     

Surgery or radiotherapy for early stages carcinomas of the glottic larynx.

AIMS AND BACKGROUND: The choice of treatment in limited squamous cell carcinoma of the glottic larynx often depends on individual and tumor factors. Data of the literature clearly show that surgery and radiotherapy tend to give identical results in terms of survival. We examined 196 cases of T1-T2/N0 cancers of the glottic larynx. We review the literature and discuss the indications and the efficacy of the various available treatments. METHODS AND STUDY DESIGN: 196 consecutive cases of T1-T2/N0 cancers of the glottic larynx were examined. In 54.5% the tumor was confined to the vocal cord; in 38.2% it extended to the anterior commissure, in 4.6% to the arytenoid cartilage and in 2.5% to the floor of the ventricle. We performed partial laryngeal surgery in 41.3% (81 cases). Radiotherapy alone was employed in 58.6% (115 cases). RESULTS: In T1a and T1b cases there was no statistically significant difference in 5-year disease-free survival. In T2 cases the NED survival of patients who underwent partial laryngectomies (90% of cases) was significantly better (P <0.05) than among patients given radiotherapy (73%). NED survival at 5 years in patients with the primary tumor on a vocal cord, ventricle or anterior commissure was 78%, 80% and 81%, respectively, with no statistically significant difference among the various sites. It is possible that involvement of the anterior commissure exposes patients to greater risk of recurrence when radiotherapy alone is used (5 out of 23 cases, 21.7%, compared to 3 out of 52 cases, 5.7%, among our surgically treated patients). CONCLUSIONS: When the tumor is confined to the vocal cord and mobility is not impaired (T1a), surgery and radiotherapy give comparable results, and the latter yields a better functional outcome. When the anterior commissure is involved, recurrences appear to be less likely after surgery. In T2 glottic carcinoma, surgery gives better results than radiotherapy alone. In any event, the choice of treatment should be patient-specific and based on a careful analysis of the factors involved in each case.     

Treatment results of oral verrucous carcinoma and its biological behavior

The biologic behavior of and optimal treatment for oral verrucous carcinoma (VC) remain controversial. We analyzed the clinicopathological characteristics of 12 patients with oral VC. Immunohistochemical techniques were used to evaluate p53 protein, CD44 variant 9, and proliferating cell nucleus antigen. The TNM classification (UICC, 1997) was T1 in 1 patient, T2 in 3, T3 in 4, and T4 in 4. All patients were classified as N0M0. Four patients were treated by surgery alone and 8 by surgery after chemotherapy, radiotherapy, or both. After surgery, two patients had primary recurrence of disease. Immunohistochemically, the proliferative activity of tumor cells as evaluated by proliferating cell nuclear antigen labeling index and p53 protein expression was similar in VC and well-differentiated squamous cell carcinoma. However, CD44 varient 9 expression was positive in 8 of 10 VC, suggesting that oral VC is associated with a low risk of lymph node metastasis. Positive CD44 variant 9 expression by most oral VCs, indicating a low risk of cervical lymph node metastasis, suggests that most cases can be controlled by surgical intervention.     

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。     

Radiotherapy for prostate carcinoma

The charts of 96 patients who received radiotherapy at The M. S. Hershey Medical Center for their prostatic carcinoma were reviewed. The 4-year NED (no evidence of disease) survival rates for patients receiving between 6,500 and 7,000 rad of external beam radiation (EBR) were 92, 78, 56, and 50% for stages A, B, C, and D1, respectively. The 4-year NED survival rate for stage B patients was 90% for those receiving approximately 6,500 rad of EBR, 75% for those receiving approximately 7,000 rad of EBR, and 71% for those receiving interstitial implants. Bowel or urinary complications occurred in 27% (21% grade I, 3% grade II, and 3% grade III) of those receiving approximately 6,500 rad of EBR, 40% (25% grade I, 10% grade II, and 5% grade III) of those receiving 7,000 rad of EBR, and 0% of those receiving interstitial implants. The effects of stage, grade, and treatment type on NED survival and complications are discussed.     

Effect of treatment time on outcome of radiotherapy for oral tongue carcinoma

PURPOSE: To investigate the importance of total treatment time on the outcome of external beam radiotherapy (EBRT) followed by internal brachytherapy for the treatment of oral tongue carcinoma. METHODS AND MATERIALS: Ninety-four patients with T1-T2N0 squamous cell carcinoma of the oral tongue were treated using 35-40 Gy EBRT followed by 35-40 Gy interstitial (137)Cs brachytherapy between 1985 and 1995. The interval between the end of EBRT and the start of interstitial treatment varied for numerous unavoidable reasons, with a mean of 25.3 days and standard deviation of 3.5 days. The median follow-up period was 59.1 months (range 6-146). RESULTS: The actuarial survival rate of all cases was 78.4% at 5 years. The 5-year local control rate for those with T1 and T2 was 92.8% and 62.7%, respectively (p < 0.05). The local control rate of the primary tumor in patients with a total treatment time >43 days was statistically lower than that of patients with a total treatment time < or =43 days in all patients (p < 0.05) and in the subgroup of Stage T2 patients (p < 0.05). Multivariate analysis revealed that the local control rates in all cases were significantly related to the T stage (T2 or not), total treatment time (>43 days or not), and location of disease (posterior or not). Regression analysis for 5-year local control as a function of treatment duration showed a 2% loss of local control per day of treatment extension >30 days (r = 0.94, p < 0.01). CONCLUSION: The total treatment time was associated with the local control rate in the RT of oral tongue carcinoma. The loss in local control was estimated to be 2.0% per additional day in our series for oral tongue carcinoma.     

紫杉醇脂质体联合奈达铂同步放化疗治疗中晚期宫颈鳞癌

[目的]探讨紫杉醇脂质体联合奈达铂同步放化疗治疗中晚期宫颈鳞癌患者的疗效及不良反应。[方法]对26例病理确诊的Ⅱb～Ⅳa期宫颈鳞癌患者采用盆腔外照射+高剂量率腔内后装放疗及同期化疗,化疗方案为:紫杉醇脂质体40mg/m2+奈达铂20mg/m2,每周1次,共6次。观察近期疗效、1、2、3年生存率及化疗、放疗不良反应。[结果]完全缓解(CR)20例(76.9%),部分缓解(PR)5例(19.2%),稳定(SD)1例(3.8%),进展(PD)0例,有效率(RR)为96.2%(25/26)。1、2、3年生存率分别为96.2%、88.5%、84.6%。不良反应主要为骨髓抑制、脱发及胃肠道反应,但均能耐受;放疗远期并发症发生率低且较轻。[结论]紫杉醇脂质体联合奈达铂同步放化疗治疗中晚期宫颈鳞癌的疗效好,不良反应可耐受,患者依从性高。     

上颌窦鳞状细胞癌不同治疗方式的临床疗效及预后分析

目的:探讨49例上颌窦鳞状细胞癌患者的临床疗效并分析生存率.方法:回顾性分析2000年1月至2012年1月收治的49例上颌窦鳞状细胞癌患者临床资料,分别比较单纯手术+术后放疗组患者和诱导化疗+手术+术后放疗组的5年生存率.这些病例(5年内死亡病例随访至死亡日)均随访5年以上,无1例失访.结果:49例病例资料中,随访率为100.0％.5年中29例患者死亡,总生存率为40.8％(20/49),单纯手术+术后放疗者23例,死亡患者15例,生存率为34.8％(8/23);诱导化疗+手术+术后放疗者26例,死亡患者14例,生存率为46.2％ (12/26),两组生存率比较,差异有统计学意义(P＜0.05).结论:上颌窦鳞状细胞癌主要的死亡原因与临床分期及术后复发转移密切相关,以手术为主的综合治疗有益于上颌窦鳞状细胞癌疗效的提高,控制局部瘤体病变及预防术后复发是影响上颌窦鳞状细胞癌疗效的关键.     

早期宫颈癌术后预后与不同放疗方式的疗效及并发症比较

  目的  探讨影响早期宫颈癌患者术后预后的因素和不同放疗方式的疗效及并发症情况。  方法  回顾性分析2013年3月至9月100例新疆医科大学附属肿瘤医院及中山大学附属肿瘤医院收治的早期宫颈癌术后患者资料,并对影响患者预后的因素进行分析。根据放疗方式分为常规放疗（conventional radiotherapy,CRT）组50例,图像引导调强放疗（image guided radiotherapy,IGRT）组50例,并比较两组的疗效和并发症情况。  结果  100例患者3年生存率和无瘤生存率分别为89%和78%。CRT组和IGRT组3年生存率分别为78.57%和89.06%,两组比较差异具有统计学意义（P=0.034）;CRT组和IGRT组3年无瘤生存率分别为66.67%和87.36%,两组比较差异具有统计学意义（P=0.042）。CRT组和IGRT组早期、晚期并发症的比较差异具有统计学意义（P < 0.05）。单因素分析显示宫旁浸润、淋巴结转移、肿瘤浸润深度、淋巴脉管间隙浸润、神经侵犯、术后放疗与早期宫颈癌3年生存率相关（P < 0.05）。Cox多因素分析显示术后放疗方式、宫旁浸润、淋巴结转移、淋巴脉管间隙浸润、神经侵犯及肿瘤浸润深度均为影响早期宫颈癌患者预后的独立危险因素。  结论  早期宫颈癌的预后是多因素相互作用的结果,术后IGRT组3年生存率明显优于CRT组,放疗不良反应小,有益于患者的生存质量。      

Proliferative verrucous leukoplakia and its related lesions

Proliferative verrucous leukoplakia (PVL) is a unique type of clinical oral leukoplakia. Enigmatic in etiology, PVL behaves in a far more aggressive fashion than other forms of leukoplakia. Its aggressiveness relates not only to a high recurrence rate, but more so to a very high level of and relentless progression from a localized simple keratosis to extensive oral disease and squamous carcinomas of verrucous, or conventional squamous cell type. Diagnosis is often late in the protracted course of PVL with the disease in an advanced stage when it is especially refractory to treatment. Within the histologic spectrum that is seen in PVL, usually as a function of time, are: (1) verrucous hyperplasia (VH), a histologically defined lesion; (2) varying degrees of dysplasia; and (3) three forms of squamous cell carcinoma: verrucous, conventional and, according to some, papillary squamous cell carcinoma. Each of these are discussed both within and outside the context of PVL. VH is a forerunner of verrucous carcinoma and the transition is so consistent that the hyperplasia, once diagnosed, should be treated like verrucous carcinoma. VH is not only an oral lesion; it can occur in the upper airway (sinonasal tract and larynx) where it is not usually found within a maternal soil of PVL. Papillary squamous cell carcinoma has been a loosely defined neoplasm, more often considered a verrucal type of malignancy. It nonetheless is a distinct clinicopathologic entity, separate from verrucous carcinoma and without a predilection for the oral cavity or an association with PVL.     

Cervico-facial adenoid cystic carcinoma: study of 102 cases. Influence of radiation therapy

One hundred two patients with cervico-facial adenoid cystic carcinoma were treated with surgery alone, radiotherapy alone or both from 1951 to 1980. All the cases have a 5-year minimum follow-up. The local control rate is 55.5% at 5 years and 37.7% at 10 years. The 5-year local control rate is 44% with surgery alone, 65.8% with radiotherapy alone and 77.8% with post-operative radiotherapy. The difference between surgery alone and radiosurgical association is significant (p less than 0.01). The bone involvement diminished local control rate (32.2%/k 68.8%). The 5-year survival rate of the patients who recurred and have been retreated is 70.5%. The 5-year survival rate of the patients after the appearance of a metastasis is 38.1% and 2 patients have survived more than 10 years. The NED 5-year survival rate is 48.8%. There is no significant difference in the NED 5-year survival rate according to sites or treatments. The crude 5-year survival rate is 70%, 51.4% at 10 years and 32.2% at 15 years. Our study shows that adenoid cystic carcinoma have a peculiar and slow evolution. Surgery with post-operative radiotherapy obtains the best local control. These results and the radiosensibility of these lesions allow us to propose an aggressive treatment for the recurrence and the primary tumor of the directly metastatic patients.     

Ⅲa期非小细胞肺癌术后辅助放射治疗疗效分析

目的　探讨Ⅲa期非小细胞肺癌（NSCLC）术后预防性照射的临床意义。方法　回顾性分析250例 Ⅲa期NSCLC患者术后放射治疗与未放射治疗的生存率及复发情况。其中术后放射治疗115例,未放射治疗135例。肺鳞癌136例,放射治疗70例,未放射治疗66例。肺腺癌75例,肺鳞腺癌及其它类型39例。结果　术后放射治疗5年生存率为24.3%,未予放射治疗5年生存率为14.2%,两组比较有显著差别（P<0.05）。肺鳞癌术后放射治疗5年生存率(26.7%)明显高于未放射治疗者(14.6%)(P<0.05)。结论　能手术切除的Ⅲa期非小细胞肺癌术后应给予预防性照射,以期提高生存期。