I,II期舌癌における低線量外照射,低用量化学療法の併用の有用性 局所制御とsubclinical neck metastasesに対する有用性について:局所制御とsubclinical neck metastasesに対する有用性について  [in Japanese] Usefulness of low-dose external beam irradiation to the oral cavity and upper neck with or without low-dose chemotherapy in combination with local irradiation for stage I and II tongue carcinoma.  [in Japanese]

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Abstract

放射線治療を施行したI, II期舌癌に対し, 原発巣への照射の前に併用した口腔, 上頸部への低線量外照射および低用量化学療法の併用の有用性を検討した. 1978~1996年に放射線治療を施行したI, II期舌癌53例 (I期17例, II期36例) を対象とした. 原発巣への照射は組織内照射49例, 電子線照射4例であった.53例のうち浸潤が深い症例, 腫瘍の辺縁が不明瞭な症例, 大きなT2症例など原発巣の制御が困難と考えられた17例 (I期2例, II期15例) には局所照射前に1回2.5Gy, 週5回照射で計25Gyを原則とした外照射を口腔, 上頸部に加えた. 外照射を加えた17例のうち8例にはペプロマイシンまたはブレオマイシンによる低用量化学療法を同時併用した. 外照射併用例, 非併用例の5年生存率はそれぞれ79.4%, 67.9%, 局所制御率は68.8%, 82.9%でいずれも有意差はなかった. 5年頸部リンパ節非再発率はそれぞれ92.9%, 66.7%で, 有意差を認めた (P<0.05).外照射併用例のうち低用量化学療法の同時併用例と非併用例の間には生存率, 局所制御率, 頸部リンパ節再発率のいずれも有意差は認めなかった. 下顎骨壊死は外照射併用例で1例, 非併用例で1例みられ, 外照射の有無により発生率には有意差はみられなかった.1回2.5Gy, 週5回照射で計25Gyを原則とした外照射は, 潜在性頸部リンパ節転移には有効と思われたが, 局所制御に対する有効性を示せなかった.

The usefulness of low-dose external beam irradiation (LDE) to the oral cavity and upper neck with or without low-dose chemotherapy before local irradiation in stage I and II tongue carcinoma were evaluated. From 1978 to 1996, fifty-three patients with stage I and II tongue carcinoma (stage I: 17, stage II: 36) were treated with radiation therapy. Tongue tumors were irradiated with radium needle implantation in 49 patients, and with an electron beam in 4 patients. In 17 of the 53 patients (stage I: 2, stage II: 15) with an unfavorable primary tumor such as a deep infiltrated tumor, ill-defined tumor or large T2 tumor, LDE with a total dose of 25 Gy or less and a daily fraction size of 2.5 Gy was administered before local irradiation. In 8 of 17 patients, low-dose chemotherapy with peplomycine or bleomycine was administered concurrently. Five-year survival rates of patients with or without LDE were 79.4% and 67.9%, respectively. Five-year local control rates of patients with or without LDE were 68.8% and 82.9%, respectively. Five-year neck disease free rates of patients with or without LDE were 92.9% and 66.7%, respectively (P<0.05). Mandibular osteonecrosis occurred in 1 of 17 (5.9%) patients with LDE and in one of 36 (2.8%) patients without LDE. In stage I and II tongue carcinoma, LDE with a daily fraction size of 2.5 Gy with or without concurrent low-dose chemotherapy is effective for subclinical neck lymph node metastases, but it may be insufficient as supporting therapy for local control in patients with unfavorable primary tumors.

Journal

  • The Journal of JASTRO

    The Journal of JASTRO 12(1), 13-21, 2000

    Japanese Society for Therapeutic Radiology and Oncology

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