术前放疗控制声门上型喉癌患者的颈部复发

目的 研究术前放疗对声门上型喉癌患者颈癌淋巴结控制作用。方法 随机对照的声门型喉癌患者共２１０例,９例失随,不包括在此分析中,其余２０１例均随诊３年以上或到死亡,其中放疗＋手术９９例（包括１５例未完成治疗）,订前放疗量４０Ｇｙ,单纯手术１０２例。结果 两组Ｋａｐｌａｎ－Ｍｅｉｅｒ生存曲线差异无显著性;采用Ｃｏｘ回归模型分析发现,与单纯手术组相比,放疗＋手术组颈部复发的相对危险性有下降趋势。放疗＋手

Preoperative radiotherapy reduces cervical metastasis of supraglottic carcinoma: a prospective randomized trial in 201 patients

OBJECTIVE: To evaluate the effectiveness of preoperative radiotherapy in the control of overall cervical lymph node metastasis from supraglottic carcinoma. METHODS: A prospective randomized study on 210 patients with supraglottic carcinoma was performed. Nine patients were lost from follow-up and therefore excluded. The analysis was based on the remained 201 patients including fifteen who did not complete the treatment protocol. Surgery alone(S) was carried out in 102 patients and radiotherapy(40 Gy) followed by surgery (R + S) in 99 patients. All the patients were followed up for more than three years. RESULTS: No statistically significant difference in survival rates between S and R + S groups was found by using the Kaplan-Meier analysis. However, relative risk of overall cervical recurrence had a trend of reduction for patients in R + S group, versus patients in S group. There was a statistically significant reduction of lymph node metastasis in R + S group compared to S group in stage I-III(P = 0.0198) while in stage IV no such difference was observed. Patients with stage I-III disease who did not receive preoperative radiation were 1.766 times more likely to develop neck recurrence compared to patients who did. Among all the factors, only TNM stage and histological nodal status were found to be independent risk factors for regional control. Contralateral neck failure occurred more frequently in patients with advanced lesion(P = 0.020) and in patients without preoperative radiation(P = 0.018). CONCLUSION: There may be a trend towards improved control of cervical lymph node metastasis with preoperative radiation of 40 Gy dose in patients with supraglottic cancer in stage I-III of the disease.