CAJ | 학술논문

目的总结下咽癌手术及术后放射治疗(放疗)的疗效,分析影响下咽癌预后的因素.方法 2003年6月至2010年6月手术治疗149例原发下咽鳞状细胞癌患者,其中梨状窝癌121例,下咽后壁癌21例,环后区癌7例;Ⅰ期3例,Ⅱ期15例,Ⅲ期29例,Ⅳ期102例.原发灶切除方式:单纯梨状窝或下咽后壁切除22例,下咽部分切除喉部分切除29例,下咽部分切除喉全切除67例,下咽和喉全切除16例,喉全切除下咽颈段食管切除12例,喉和下咽食管全切除3例.其中保留喉功能者51例(34.2％),未保留98例(65.8％).均行双侧择区性或根治性颈淋巴清扫术,79例同期行一侧或双侧甲状腺切除术.87例于我院肿瘤中心接受适形调强放疗,根据手术切除情况有针对性地进行放疗野的调整;49例在其他医院放疗;剂量50 ～ 70 Gy.结果 149例患者中没有失访病例,治疗满5年者共111例,Kaplan-Meire统计3年生存率为47.7％,5年生存率为38.7％.T1-2与T3-4组间,颈淋巴有转移与无转移组间,Ⅰ-Ⅱ期与Ⅲ-Ⅳ期组间,保留喉功能与不保留喉功能组间的3年生存率差异均无统计学意义(P值均＞0.05).未放疗患者、本院放疗与外院放疗患者三组间3年生存率总体比较差异有统计学意义(x2 =6.851,P＜0.05).86例死亡患者主要死因分别为颈淋巴结转移25例(29.1％),包括咽后淋巴结转移9例和气管造口复发癌1例;远处转移19例(22.1％);局部复发13例(15.1％);局部或区域合并远处转移8例(9.3％);第二原发癌6例(7.0％).结论下咽癌仍是疗效较差的头颈部恶性肿瘤,术后采用调强放疗并根据切除情况有针对性地进行放疗野的调整,有助于提高下咽癌的疗效.
목적 총결하인암수술급술후방사치료(방료)적료효,분석영향하인암예후적인소.방법 2003년6월지2010년6월수술치료149례원발하인린상세포암환자,기중리상와암121례,하인후벽암21례,배후구암7례;Ⅰ기3례,Ⅱ기15례,Ⅲ기29례,Ⅳ기102례.원발조절제방식:단순리상와혹하인후벽절제22례,하인부분절제후부분절제29례,하인부분절제후전절제67례,하인화후전절제16례,후전절제하인경단식관절제12례,후화하인식관전절제3례.기중보류후공능자51례(34.2％),미보류98례(65.8％).균행쌍측택구성혹근치성경림파청소술,79례동기행일측혹쌍측갑상선절제술.87례우아원종류중심접수괄형조강방료,근거수술절제정황유침대성지진행방료야적조정;49례재기타의원방료;제량50 ～ 70 Gy.결과 149례환자중몰유실방병례,치료만5년자공111례,Kaplan-Meire통계3년생존솔위47.7％,5년생존솔위38.7％.T1-2여T3-4조간,경림파유전이여무전이조간,Ⅰ-Ⅱ기여Ⅲ-Ⅳ기조간,보류후공능여불보류후공능조간적3년생존솔차이균무통계학의의(P치균＞0.05).미방료환자、본원방료여외원방료환자삼조간3년생존솔총체비교차이유통계학의의(x2 =6.851,P＜0.05).86례사망환자주요사인분별위경림파결전이25례(29.1％),포괄인후림파결전이9례화기관조구복발암1례;원처전이19례(22.1％);국부복발13례(15.1％);국부혹구역합병원처전이8례(9.3％);제이원발암6례(7.0％).결론 하인암잉시료효교차적두경부악성종류,술후채용조강방료병근거절제정황유침대성지진행방료야적조정,유조우제고하인암적료효.
Objective To investigate the efficacy of surgery followed by adjuvant radiotherapy and the prognostic factors affecting the results of treatment in hypopharyngeal carcinoma.Methods A retrospective review of 149 patients with hypopharyngeal carcinoma that received surgical treatment from Jun 2003 to Jun 2010 was accomplished.In the 149 patients,the site of origin were pyriform sinus (n =121),posterior pharyngeal wall (n =21) and postcricoid (n =7).According to UICC 2002 criteria,there were 3 in stage Ⅰ,15 in stage Ⅱ,29 in stage Ⅲ and 102 in stage Ⅳ.Surgical methods for primary tumor were:pyriform sinus resection or posterior pharyngeal wall resection in 22 cases,partial pharyngectomy and partial laryngectomy in 29 cases,partial pharyngectomy and total laryngectomy in 67 cases,total pharyngectomy and total laryngectomy in 16 cases,total pharyngolaryngectomy and partial esophagus resection in 12 cases,and total esophagus resection in 3 cases.All the patients received elective and/or radical neck dissection.Unilateral or bilateral thyroid lobectomy was performed in 98 cases.Eighty-seven patients received intensity modulation radiated therapy (IMRT) postoperatively in the cancer center of Provincial Hospital Affiliated to Shandong University.Individualized adjustment of the radiation field was made according to the surgical condition.Forty-nine cases received radiotherapy in other hospitals (dose 50-70 Gy).Laryngeal function was restored in 51 patients (34.2％).The risk clinicopathological factors of survival and the causes of death were analyzed.Results The survival rate was calculated with Kaplan-Meier method.The overall 3-and 5-year survival rates were 47.7％ and 38.7％,respectively.There were no significant differences in 3-year survival between T1-2 and T3-4 groups,N0 and N + groups,stage Ⅰ-Ⅱ and Ⅲ-Ⅳ groups,laryngeal function preserved and unpreserved groups.The overall 3 years survival rate of patients received surgery and adjuvant radiotherapy was higher than those just received surgery alone (x2 =6.851,P ＜ 0.05).The 3-year survival rate in patients treated in comprehensive treatment group has showed a good trend,although still no statistical significance (x2 =0.176,P ＞ 0.05).The cause of death in 86 patients,including regional lymph nodes recurrence in 25 cases (29.1％).Of them,one was stoma recurrence and 9 were retropharyngeal lymph nodes metastasis; distant metastasis in 19 cases (22.1％) ; local recurrence in 13 cases,local or regional recurrence with distant metastasis in 8 cases (9.3％),and second primary cancer in 6 cases (7.0％).Conclusions The overall prognosis of hypopharyngeal carcinoma was poor and dismal.In accordance with specific conditions of surgery,active adjustment of the personalized protocol of IMRT was the key of improving the efficacy of hypopharyngeal carcinoma.