中咽頭癌の集学的治療の成績 過去の成績との比較検討

Abstract

Recently in the Kurume University Hospital patients with carcinoma of the oropharynx have undergone the combined therapy approach by team practice, involving otolaryngologists, radiologists and plastic and reconstructive surgeons. In this paper this treatment modality by this team practice was described in detail and treatment outcome was compared with the previous outcome.The details of this combined therapy approach are as follows. Specialists in otolaryngology and radiology initially discuss and determine the choice of treatment modalities before initiating treatments. The response during treatments is then evaluated by otolaryngologists and radiologists and the treatment modalities are flexibly modified. When some kind of reconstruction is required during the operation, both otolaryngologists and plastic surgeons see the patient together and determine the surgical procedure before the operation. Functional problems such as aspiration after the operation are managed based on discussions between otolaryngologists and plastic surgeons.66 patients (60 males and 6 females) were treated before the application of this combined therapy and 67 patients (55 males and 12 females) were treated after initiating this combined therapy in the Kurume University Hospital. The five year local control rate for patients before combined therapy was 59.5% while that after combined therapy was 69.8%. The disease specific five year survival rate for patients before combined therapy was 54.9% while that after combined therapy was 71.8%.These results suggest that the most problematic points for the treatments of carcinoma of the oropharynx are as follows. The treatment outcome for carcinoma of the posterior wall remains very poor. It also remains difficult to conserve the larynx for carcinoma of the anterior wall. The treatment outcomes for carcinoma of the lateral wall are not significantly improved by a combined therapy, and the outcomes of salvage operations are still unsatisfactory.