原文題目

原文題目(出處)： Radiotherapy with or without chemotherapy for patients with T1-T2 glottic carcinoma: retrospective analysis 原文作者姓名： Stuart C. White, and Michael J. Pharoah

通訊作者學校： Nagoya University graduate school of medicine 報告者姓名(組別)： 陳科名 Intern D 組

報告日期： 2010/11/09

內文：

Background

 Glottic carcinoma (GC)是最常見喉部的癌症，因為聲音會沙啞所以可以早期 就被發現。

 RT is the preferred therapeutic method in early GC.

 TNM 分期：

T1 a：腫瘤最大直徑不超過 2 公分 (Tumor ≦ 2 cm)

T1b：腫瘤最大直徑超過 2 公分，但是不超過 3 公分。 (Tumor >2 cm but ≦ 3 cm)

T2：腫瘤最大直徑超過 3 公分 ，但是不超過 7 公分。

 The purpose of this study was to review retrospectively our experience in the treatment of T1 and T2 GC through RT with or without chemotherapy from 2001 to 2006.

Methods

Patient characteristics

 58 patients who had undergone radical RT with or without chemotherapy to the larynx for Stage I-II GC (T1-T2)

 Patients were treated at Nagoya University Hospital between January 2001 and April 2006

 All patients were followed for a median period of 48 months (range, 13-84 months) or until death.

Treatments detail

 Thirty-nine patients were treated with RT alone; 19 received RT and chemotherapy.

Chemotherapy

 Low dose of CDDP ：consisting of 60-min administration of CDDP at a dose of 5 mg/body after RT.

 Low-dose CDDP/5-FU：continuously administered via different routes through a catheter placed in the central vein.

 High dose of CDDP/5-FU：continuous infusion of 5-FU at a dose of 700 mg/m²/ day on days 1-4, combined with a 2-hr infusion of CDDP at a dose of 70

mg/m²/day on day 1.

 The daily dose of 5-FU was given at 200 mg/m², and that of CDDP was 4 mg/m².

 CDDP and 5-FU were administered for 24 hr every day, except Saturday and Sunday, from the day irradiation was started.

 In three patients treated with chemoradiotherapy (two cases) or RT alone (one case), tumor responses were very poor. For these patients, treatments were discontinued at 18 Gy, 36 Gy, and 52 Gy, and partial laryngectomies were performed.

Statistical Analysis

 Local control (LC) and total laryngectomy-free survival were assessed from the beginning of RT until evidence of recurrence or until laryngectomy.

 In the univariate analysis, the variables analyzed included age (63 > vs. ≤ 63), T category (T1 vs. T2), overall treatment time (> 49 vs. ≤ 49), and chemotherapy (combined. vs. not combined).

Follow-up

 After RT alone or combined with chemotherapy, the patients were evaluated at 1-month intervals for the first year, at 2-month intervals during the second year, every 3 months during the third year, every 4 months during the fourth year, and every 6 months thereafter.

 The patients who presented with recurrence of disease in the follow-up time submitted to salvage treatment by total or partial laryngectomy.

Results

Local control and patterns of failure

 For all 58 patients, the 5-year LC rate was 84.3%. The 5- year LC rates for T1a, Tb, and T2 were 85.9%, 83%, and 85%, respectively. The difference between the sub-stage LC rates was not statistically significant.

58 patients

8 p’t developed recurrent disease at the primary site

1 p’t lymph node recurrences

3 p’t tumor responses were very poor

52 Gy (T2) 36 Gy (T2)

18 Gy (bulky T1b)

Partial laryngectomy 4 p’t salvage surgery

1 p’t refused surgery

Univariate analysis

 Results of univariate analysis showed no statistical significance for any of the variables.

Complications

 There were no severe acute complications

 No late complications such as chondronecrosis were seen, and no patients required hospitalization due to complications.

Second primary cancers

58 patients

12 p’t (20%) had second primary cancers

2 p‘t (3%) had third cancers

75% were in the upper aerodigestive tract

 The 5-year survival rate in 12 patients with double primary cancers was 74.0%, and that in 46 patients without double or triple cancers was 92.5% (p = 0.18).

Discussion

 The difference between the sub-stage LC rates was not statistically significant.

 In the univariate analysis for combined chemotherapy for LC, the difference had no statistical significance.

 Several analyses of the risk of local failure after RT for early GC have shown the probability of success to be closely related to the volume or bulk of the lesion

 Recent studies have shown an improvement in LC for patients with T1 and T2 GC when total radiation is delivered in a shorter overall treatment time with a high-dose fractionation or hyperfractionation schedule.

 In contrast, several other reports have indicated that chemoradiation for T2GC is promising and that LC rates are higher than those for RT alone in Japan.

 If poor responses to radiotherapy with or without chemotherapy can be predicted, surgery or another procedure may be selected.

 In the present study, a second malignancy occurred in more than 20% of the cases, 75% of which were in the upper aerodigestive tract.

 The prognoses for patients with a second malignancy were poorer than those of patients with a single malignancy, though the difference was not statistically significant.

Conclusions

 By means of radiotherapy with or without chemotherapy, we achieved a high rate of LC in patients with T1-T2 GC. Although the combination therapy yielded the most favorable results, there was no statistical difference in the LC rates.

題號 題目

1

(A) 分裂速率快 (B) 細胞數量多

(C) 未來將進行多次有絲分裂 (D) 未分化的原始細胞

答案(B) 出處：Oral Radiology - Principles and Interpretation, 6th Edition, 2009 ,P30

題號 題目

2

(A) 不變 (B) 增加 (C) 減少 (D) 先增後減

答案(B) 出處：Oral Radiology - Principles and Interpretation, 6th Edition, 2009 ,P32