進行・再発頭頸部癌の温熱化学放射線療法 : 背景因子からみた治療成績 THERMOCHEMORADIOTHERAPY FOR ADVANCED OR RECURRENT HEAD AND NECK CANCER : ANALYSIS OF CLINICAL RESULTS AND BACKGROUND VARIABLES

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著者

    • 星名 秀行 HOSHINA Hideyuki
    • 新潟大学歯学部口腔外科学第二講座 Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Niigata University
    • 高木 律男 TAKAGI Ritsuo
    • 新潟大学歯学部口腔外科学第二講座 Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Niigata University
    • 長島 克弘 NAGASHIMA Katsuhiro
    • 新潟大学歯学部口腔外科学第二講座 Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Niigata University
    • 藤田 一 FUJITA Hajime
    • 新潟大学歯学部口腔外科学第二講座 Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Niigata University
    • 宮本 猛 MIYAMOTO Takeshi
    • 新潟大学歯学部口腔外科学第二講座 Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Niigata University
    • 相馬 陽 SOHMA Yoh
    • 新潟大学歯学部口腔外科学第二講座 Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Niigata University
    • 福田 純一 FUKUDA Jun-ichi
    • 新潟大学歯学部口腔外科学第二講座 Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Niigata University
    • 今井 信行 IMAI Nobuyuki
    • 新潟大学歯学部口腔外科学第二講座 Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Niigata University
    • 永田 昌毅 NAGATA Masaki
    • 新潟大学歯学部口腔外科学第二講座 Second Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Niigata University

抄録

当科において温熱化学 (CDDP) 放射線療法を施行した進行・再発頭頸部癌 (扁平上皮癌) 18例, 25病巣の背景因子 (腫瘍因子, 治療因子) を調査し, 治療成績 (腫瘍縮小率, 5年累積病巣制御率) との関係について, 統計学的に解析し, 以下の結果を得た。WHO組織学的分類3型の治療成績は1, 2型より低下し, 単変量解析では有意差が認められたが, 多変量解析ではWHO分類は有意に関係する因子ではなかった。骨に囲まれた, 原発巣の治療成績は軟組織の病巣よりやや低下がみられたが, 有意差は認められなかった。その他には治療成績に関係する背景因子はなく, 制御が困難とされる再発巣, 大きな腫瘍, 高度浸潤性癌に対しても, 十分な治療成績が得られていた。加温方法や加温回数, 50Gy以上の放射線量, CDDPの投与量や併用薬剤と, 治療成績との間には相関は認められなかった。以上, 進行・再発頭頸部癌の温熱化学放射線療法について, 予後因子はみあたらず, 本法は有力な治療法であると考えられた。

Eighteen patients with 25 unresectable advanced or recurrent head and neck cancers (squamous cell carcinomas) received thermochemotherapy in combination with radiotherapy. The total radiation dose ranged from 50 to 82 Gy (mean, 65.6Gy). Patients received thermochemotherapy twice a week, for a total number of 8.8 sessions, on average. The temperature in the tumor, as a result of the hyperthermia, was over 42°C in 185 (84.5%) of the 219 treatments. Three kinds of heating systems were used: a 13.56-MHz radiofrequency system, a 2450-MHz microwave system, and a radiofrequency interstitial system. The total amount of administered CDDP ranged from 40 to 300mg (mean, 110mg), combined with PEP and/or 5FU. Background factors (tumor factors and treatment factors) were investigated in detail, and the clinical results (tumor response and the 5-year cumulative focal control rate) were evaluated. The relationship between these two results was then analyzed using univariate and multivariate statistics.<br>The clinical results of patients with a WHO histological classification of grade 3 were poor compared with patients with a classification of grade 1 or 2. The difference between these two results was significant when analyzed using univariate statistics, but not significant when analyzed using multivariate statistics. The clinical results of patients with primary lesions surrounded by bony tissues were slightly poor compared with those of patients whose lesions were surrounded by soft tissues, but the difference between these two results was not significant. Successful treatment of refractory recurrent tumors, large tumor masses, and diffuse invasive carcinomas was not affected by the treatment factors (heating systems, heating sessions, radiation dose, and CDDP dose and drug combination).<br>These results suggest that refractory recurrence, proximity to bony tissues, tumor size, and histological malignancy might not be prognostic variables for thermochemoradiotherapy strategy in patients with advanced or recurrent head and neck cancers.

収録刊行物

  • 頭頚部腫瘍

    頭頚部腫瘍 27(1), 181-186, 2001-03-25

    Japan Society for Head and Neck Cancer

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各種コード

  • NII論文ID(NAID)
    10012170270
  • NII書誌ID(NCID)
    AN00165234
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    09114335
  • データ提供元
    CJP書誌  J-STAGE 
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