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目的 对无手术条件的口腔恶性肿瘤患者应用大剂量二次放疗作回顾性分析 ,对治疗效果和应用前景进行评估。方法 对 118例无手术条件但未转移 ,已经过首次放疗的口腔恶性肿瘤患者进行第二次照射。采用单纯放疗患者 18例 ,2 GY× 30天 ;放化疗结合 76例 ,2 GY× 30天 ;2 4例化疗与分次放疗结合 ,2× 1.5 GY× 2 0天。结果 采用大剂量二次放疗患者生存率明显高于单独化疗者 ,放疗晚期并发症包括颈部瘢痕 36 % ,粘膜坏死 19% ,放射性骨坏死 18% ,张口受限14%。二次放疗的体积是与死亡危险度相关的唯一因素 ,相关度为 1.75。结论 对没有手术指征的口腔恶性肿瘤患者采用大剂量放疗与化疗相结合是可行的。虽然后期并发症的发病率和严重程度与第一次放疗相比明显增加 ,但平均存活时间较单独化疗者长
Objective To retrospectively analyze the effect of high-dose second-dose radiation on patients with oral malignant tumor without surgical conditions and to evaluate the therapeutic effect and application prospect. Methods A total of 118 patients with oral malignant tumor who had no operation condition but had not been transferred and had been treated for the first time underwent the second irradiation. 18 patients were treated with radiotherapy alone, 2 GY × 30 days; radiotherapy and chemotherapy combined 76 cases, 2 GY × 30 days; 24 cases of chemotherapy combined with fractional radiotherapy, 2 × 1.5 GY × 20 days. Results The survival rate of patients receiving chemotherapy with high dose of radiotherapy was significantly higher than that of chemotherapy alone. The complications of advanced radiotherapy included neck scar 36%, mucosal necrosis 19%, radioactive osteonecrosis 18% and mouth opening 14%. The volume of second radiation was the only factor associated with the risk of death with a correlation of 1.75. Conclusion It is feasible to use high-dose radiotherapy combined with chemotherapy in patients with oral malignancies without surgical indications. Although the incidence and severity of postoperative complications significantly increased compared with the first radiation, the mean survival time was longer than that of chemotherapy alone