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目的 比较 132例T1、T2 期下咽癌患者手术 +放射治疗与单纯放射治疗的疗效。方法 132例T1、T2 期下咽癌患者中 ,5 1.5 %肿瘤直径在 2～ 4cm范围内 ,83.3%来源于梨状窝。颈部淋巴结阴性 (N0 )者占总数的 5 0 %。治疗分为 3个组 ,即部分咽喉切除术 +术后放射治疗 (PPL +RX)组 (4 4例 ) ,全咽喉切除术 +术后放射治疗 (TPL +RX)组 (4 0例 ) ,单纯放射治疗 (RX)组 (4 8例 )。术后放射治疗原发灶区和 (或 )颈淋巴引流区的放射剂量为 45～ 5 5Gy。单纯放射治疗的照射剂量原发灶区为 75Gy,颈淋巴引流区为 45～ 5 5Gy ,颈转移淋巴结处总量达 75Gy。生存率计算采用Kaplan Meier法 ,显著性检验采用Logrank法。结果 总 1、3、5年生存率分别为 71%、45 %、34%。单纯放射治疗组与术后放射治疗组间的 1、3、5年生存率比较 ,后者治疗效果均优于前者 (PPL +RX与RX :χ2 =7.0 1,P <0 .0 1;TPL +RX与RX :χ2 =4.0 1,P <0 .0 5 )。咽喉全切除术或部分切除 +术后放射治疗组间的 1、3、5年生存率差异无显著性意义 (χ2 =1.85 ,P >0 .10 )。N0 者行颈清扫 +术后放射治疗与单纯放射治疗的颈淋巴区的控制率差异也无显著性意义 (χ2 =1.96 ,P >0 .10 ) ,但术前颈淋巴结有临床转移者 (N+)则颈清扫具有明显优势 (χ2 =12 .2 1,P
Objective To compare the efficacy of surgery + radiotherapy and radiotherapy alone in 132 patients with stage T1 and T2 hypopharyngeal carcinoma. Methods Among 132 patients with T1 and T2 hypopharyngeal carcinoma, 51.5% of the tumors were in the range of 2 ~ 4 cm in diameter and 83.3% in the pyriform sinus. Neck lymph nodes (N0) accounted for 50% of the total. The treatment group was divided into three groups: partial laryngectomy + postoperative radiotherapy (PPL + RX) group (44 cases), total laryngectomy + postoperative radiotherapy (TPL + RX) group (40 cases) Simple radiotherapy (RX) group (48 cases). Postoperative radiotherapy in the primary lesion and / or neck lymphatic drainage dose of 45 ~ 55Gy. The radiation dose of pure radiotherapy was 75Gy in primary tumor area, 45-55Gy in cervical lymphatic drainage area and 75Gy in cervical metastatic lymph node. Kaplan Meier method was used to calculate the survival rate and Logrank method to test the significance. Results The total 1, 3, 5-year survival rates were 71%, 45% and 34% respectively. The 1, 3, 5-year survival rates between the radiotherapy group and the postoperative radiotherapy group were better than the former ones (PPL + RX and RX: χ2 = 7.01, P <0.01; TPL + RX and RX: χ2 = 4.0 1, P <0.05). There was no significant difference in the 1, 3, 5-year survival rate between total laryngectomy and partial resection plus postoperative radiotherapy (χ2 = 1.85, P> 0.10). There was no significant difference in the control rate of cervical lymph node between N0 patients who underwent neck dissection and postoperative radiotherapy and radiotherapy alone (χ2 = 1.96, P> 0.10) ) Neck dissection has obvious advantages (χ2 = 12.21, P