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目的探讨颌骨原发性骨内癌(PIOC)术后放射治疗的适应证、照射范围和剂量。方法收集中国医学科学院肿瘤医院1969年10月-2005年5月治疗的13例PIOC的临床资料,并综合1969-2005年国内外27篇文献所报道的资料较为完整的46例PIOC(共59例)进行分析。结果(1)中国医学科学院肿瘤医院收治的13例PIOC均为局部晚期,1、2和3年生存率分别为59.2%、33.8%和12.7%。(2)59例PIOC 1、2和3年生存率分别为78.4%、53.9%和34.0%,其中单纯手术组1、2和3年生存率分别为81.8%、71.2%和35.1%,手术加放疗组分别为84.3%、57.2%和43.6%,两组生存率差异无统计学意义(P=0.908),但两组病例选择存在很大偏倚。分层分析显示,对于T1和T2期患者,单纯手术组的生存率高于手术加放疗组(P=0.039)。结论术后放疗可能对改善PIOC患者,尤其是T3期、颈淋巴结阳性、行局部切除术或切缘不净的PIOC患者的生存具有一定作用,其适应证为手术切缘阳性、原发灶侵及周围软组织、颈淋巴结发生转移、行病灶局部切除。
Objective To investigate the indications, irradiation range and dose of radiotherapy for postoperative primary osteoarthritis of the jaw (PIOC). Methods The clinical data of 13 cases of PIOC treated in Cancer Hospital of Chinese Academy of Medical Sciences from October 1969 to May 2005 were collected and 46 cases of PIOC (59 cases in total), which were reported in 27 literatures at home and abroad from 1969 to 2005, ) For analysis. Results (1) All the 13 cases of PIOC treated by Tumor Hospital of Chinese Academy of Medical Sciences were locally advanced. The 1, 2 and 3 year survival rates were 59.2%, 33.8% and 12.7% respectively. (2) The 1, 2 and 3-year survival rates of PIOC were 78.4%, 53.9% and 34.0% in 59 cases, respectively. Survival rates at 1, 2 and 3-year were 81.8%, 71.2% and 35.1% The radiotherapy group was 84.3%, 57.2% and 43.6% respectively, with no significant difference between the two groups (P = 0.908). However, there was a great bias in the two groups. Hierarchical analysis showed that the survival rate of patients in the surgery alone group was higher than that in the surgery plus radiotherapy group (P = 0.039). Conclusions Postoperative radiotherapy may play an important role in improving the survival of patients with PIOC, especially those with positive T3, cervical lymph nodes, partial excision or poorly margined PIOC. The indications are positive surgical margins, primary tumor invasion And the surrounding soft tissue, cervical lymph node metastasis, partial excision of the lesion.