唇癌及口腔癌调强放疗失败的临床研究  

Study on the failure patterns of lip and oral cavity cancers after intensity-modulated radiation therapy

作　　者：陆合[1] 姚敏[1,2] 

机构地区：[1]广西壮族自治区人民医院肿瘤科,南宁530021 [2]美国爱荷华大学放疗科,52242

出　　处：《临床肿瘤学杂志》2008年第7期630-634,共5页Chinese Clinical Oncology

摘　　要：目的:探讨唇部及口腔鳞状细胞癌调强放疗失败的原因。方法:55例唇部及口腔鳞状细胞癌患者接受调强放疗,其中49例为术后放疗,5例为根治性放疗,1例为新辅助放疗。通过复发时CT图像与治疗计划用CT图像的融合或对比来判断复发方式。结果:9例患者出现局部区域复发:4例仅有局部复发,2例仅有区域复发,3例局部+区域复发。5例患者出现远处转移,其中3例合并局部区域复发。2年总生存率、疾病特异性生存率、局部无复发生存率、局部区域无复发生存率、以及远处无转移生存率分别为68%、74%、85%、82%和89%。从治疗结束到局部区域复发的中位时间为4.1个月。除1例失败出现在照射野外的对侧下颈部外,其余的失败都出现在接受高量放疗的部位。局部区域控制与淋巴结包膜外侵显著相关。结论:调强放疗是唇部及口腔鳞状细胞癌的有效治疗方式。绝大多数治疗失败的方式为"照射野内"复发,建议术后同步化放疗用于有淋巴结包膜外侵的唇癌及口腔癌患者。Objective ：To investigate the failure patterns of lip and oral cavity squamous cell carcinoma treated with intensitymodulated radiation therapy（IMRT）. Methods：Fifty-five patients with lip and oral cavity SCC were treated with IMRT for curative intent. Forty-nine received postoperative IMRT,5 definitive IMRT,and 1 neoadjuvant. The failure patterns were determined by coregis- tration or comparison of the treatment planning computed tomography to the images obtained at the time of recurrence. Results： Nine patients had locoregional failures： 4 local failures only ,2 regional failures only, and 3 had both local and regional failures. Five patients failed distantly;of these,3 also had locoregional failures. The 2-year overall survival,disease-specific survival,local recurrence free survival, locoregional recurrence-free survival, and distant disease-free survival was 68% ,74% , 85% , 82% , and 89% , respectively. The median time from treatment completion to locoregional recurrence was 4. 1 months. Except for 1 patient who failed in contralateral lower neck outside the radiation field, all failed in areas that had received a high dose of radiation. The locoregional control was strongly correlated with extracapsular extension. Conclusion：IMRT is effective for lip and oral cavity squamous cell carcinoma. Most failures are in-field failures. Further clinical studies are necessary to improve the outcomes of patients with high-rlsk features, particularly for those with extracapsular extension.

关 键 词：口腔癌 唇癌 调强放疗 失败方式 

分 类 号：R739.8[医药卫生—肿瘤]