原发灶不明的颈部转移癌的放射治疗：选择性黏膜腔照射是否临床获益？

doi:10.19438/j.cjoms.2018.03.011

中国口腔颌面外科杂志 ›› 2018, Vol. 16 ›› Issue (3): 248-252.doi: 10.19438/j.cjoms.2018.03.011

原发灶不明的颈部转移癌的放射治疗：选择性黏膜腔照射是否临床获益？

冯琨，窦圣金，朱国培，张志愿

上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科，国家口腔疾病临床研究中心，上海市口腔医学重点实验室，上海市口腔医学研究所，上海200011

收稿日期:2018-01-24 修回日期:2018-04-10 出版日期:2018-05-20 发布日期:2018-06-12
通讯作者: 张志愿，E-mail:zhzhy0505@163.com
作者简介:冯琨（1982-），男，博士研究生，E-mail: 18917648787@163.com

Radiotherapy for head and neck cancer of unknown primary sites: Is there a clinical benefit to elective mucosal irradiation?

FENG Kun， DOU Sheng-jin， ZHU Guo-pei， ZHANG Zhi-yuan.

Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center of Stomatology; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. Shanghai 200011, China

Received:2018-01-24 Revised:2018-04-10 Online:2018-05-20 Published:2018-06-12

摘要/Abstract

摘要： 目的： 探讨对原发灶不明的颈部转移癌患者行黏膜腔预防性照射是否有临床获益。方法： 收集2009年1月—2016年4月接受放疗的所有原发灶不明的颈部转移癌患者的临床资料，采用SPSS 20.0软件包中的Kaplan-Meier法进行生存分析和Log-rank法检验。结果： 62例患者纳入研究，中位随访时间为63个月（5 ~126个月）。选择性黏膜腔照射组和单纯颈部处理组5年黏膜控制率分别为100%和72.0%（P=0.003），5年颈部控制率分别为92.9%和57.7%（P=0.002）。单纯颈部处理组有7例（26.9%）出现原发肿瘤，2组之间在晚期毒性方面无显著差异。结论： 选择性黏膜腔照射有助于在原发灶不明的颈部转移癌患者中寻找一种疗效和毒性之间可能的平衡，但仍需要长期随访的前瞻性研究给出更好的答案。

关键词: 原发灶不明, 颈部转移癌, 选择性黏膜腔照射, 放疗, 颈部处理

Abstract: PURPOSE: The optimal management is still controversial in head and neck cancer of unknown primary sites. Particular areas of controversy persist regarding whether elective mucosal irradiation should be performed. METHODS: Clinical data of patients with head and neck cancer of unknown primary sites treated with radiotherapy from 2009.01 to 2016.04 were retrospectively collected. Survival curves were estimated with Kaplan-Meier method and log-rank test with SPSS 20.0 software package. RESULTS: After a median follow-up of 63 months (range 5-126 months), the 5-year mucosal control rate was 100% and 72.0% (P=0.003) in patients treated with elective mucosal irradiation and neck treatment; the 5-year neck control rate was 92.9% and 57.7% (P=0.002), respectively. Primary tumor emerged in 7(26.9%) patients from the neck treatment group. CONCLUSIONS: Elective mucosal irradiation helps to provide a better balance between efficiency and toxicity in patients with head and neck cancer of unknown primary sites. Prospective study with more patients and long follow-up are needed.

Key words: Unknown primary sites, Cervical lymph node metastasis, Elective mucosal irradiation, Radiotherapy, Neck treatment

中图分类号:

R739.8

冯琨，窦圣金，朱国培，张志愿. 原发灶不明的颈部转移癌的放射治疗：选择性黏膜腔照射是否临床获益？[J]. 中国口腔颌面外科杂志, 2018, 16(3): 248-252.

FENG Kun， DOU Sheng-jin， ZHU Guo-pei， ZHANG Zhi-yuan.. Radiotherapy for head and neck cancer of unknown primary sites: Is there a clinical benefit to elective mucosal irradiation?[J]. China J Oral Maxillofac Surg, 2018, 16(3): 248-252.

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原发灶不明的颈部转移癌的放射治疗：选择性黏膜腔照射是否临床获益？

Radiotherapy for head and neck cancer of unknown primary sites: Is there a clinical benefit to elective mucosal irradiation?

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