中咽頭へん平上皮癌症例の検討

Abstract

Forty-two previously untreated patients treated for squamous cell carcinoma of the oropharynx from 1975 (opening of the department) through 1999 at our department were retrospectively reviewed in terms of the pathophysiology, survival rate and prognostic factor. The mean age of the patients was 61.0 years (45-84 years), and the ratio of males to females was 2.8:1. Many of the patients were heavy smokers and drinkers. Multiple primary cancer was detected in 14.3% of the patients. Advanced cancer (clinical stages III and IV) was noted in 76.2% of the patients. Among the 40 patients followed up, 12 had received mainly radiation therapy (in combination with chemotherapy in some cases) and 27 had been treated by surgery (in combination with radiation therapy and/or chemotherapy in some cases). One patient received neo-adjuvant chemotherapy, but he died from the adverse effects of this therapy. The 5-year survival rate in the patients treated mainly by surgery was favorable (64.7%). There were no significant differences in patient's background factors or the primary therapeutic strategy employed among the patients. There were significant differences between complete response and partial response or progression in the patients in whom only radiation or preoperative radiation was used (P<0.0042). The favorable survival rate may be explained by the use of surgery as a primary strategy, the use of preoperative radiation, and the use of surgical treatment for cases with T3, N2a or higher grade cancer, irrespective of the effect of radiation. We suggest that it is necessary to assess the effect of radiation therapy early, to consider combining it with chemotherapy, and to attempt a higher salvage rate at recurrence in order to achieve a higher salvage rate.