本文選題：晚期喉癌 + 放射治療　； 參考：《蚌埠醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景與目的:晚期喉癌(Ⅲ~Ⅳ期)的惡性程度較高,容易出現(xiàn)局部復(fù)發(fā)及遠處轉(zhuǎn)移,預(yù)后往往較差。本文對蚌埠醫(yī)學(xué)院第一附屬醫(yī)院腫瘤放療科的64例晚期術(shù)后喉癌進行回顧性分析,旨在探討術(shù)后同步放化療與術(shù)后單純放療兩種治療方案在晚期喉癌治療中的臨床療效差異并總結(jié)復(fù)發(fā)和死亡情況,分析影響晚期喉癌生存及預(yù)后相關(guān)的因素。方法:回顧性分析蚌埠醫(yī)學(xué)院第一附屬醫(yī)院腫瘤放療科2012年1月至2013年12月收治的64例晚期喉癌術(shù)后患者的臨床資料,其中Ⅲ期30例,Ⅳ期34例;聲門上型29例,聲門型32例,聲門下型3例。33例晚期喉癌患者術(shù)后接受放療聯(lián)合以鉑類為基礎(chǔ)的同步化療(同步放化療組),其中行全喉切除術(shù)者21例,行保喉手術(shù)者12例;手術(shù)后僅行單純放療31例(單純放療組),其中全喉切除者17例,保喉者14例。隨訪結(jié)束后,有3例患者失訪,其中同步放化療組2例,單純放療組1例,隨訪率95.31%。使用SPSS17.0統(tǒng)計軟件進行數(shù)據(jù)分析,運用Kaplan-meier法進行生存分析,Log-rank法進行檢驗,并對預(yù)后因素行單因素分析,應(yīng)用Cox比例風(fēng)險模型行多因素分析。結(jié)果:64例患者3年累積生存率為60.9%。同步放化療組和單純放療組3年生存率分別為77.7%和50.5%,兩組生存率差異有統(tǒng)計學(xué)意義(P0.05);兩組Ⅲ~Ⅳ級不良反應(yīng)中放射性黏膜反應(yīng)及骨髓抑制發(fā)生率差異均無統(tǒng)計學(xué)意義(P0.05),僅Ⅲ~Ⅳ級胃腸道不良反應(yīng)發(fā)生率差異有統(tǒng)計學(xué)意義(P0.05),認(rèn)為化療的應(yīng)用可增加患者胃腸道反應(yīng)的發(fā)生率。全喉切除者與保喉者3年生存率分別為73.1%和54.2%,對術(shù)式不同水平進行檢驗,差異無統(tǒng)計學(xué)意義(P0.05)。64例患者中34例出現(xiàn)復(fù)發(fā),總復(fù)發(fā)率為53.13%。其中同步放化療組11例患者復(fù)發(fā),包括原發(fā)灶復(fù)發(fā)1例,頸部復(fù)發(fā)9例,遠處轉(zhuǎn)移1例,復(fù)發(fā)率為33.33%;單純放療組23例患者復(fù)發(fā),包括原發(fā)灶復(fù)發(fā)2例,頸部復(fù)發(fā)18例,遠處轉(zhuǎn)移3例,復(fù)發(fā)率為74.19%。64例患者中25例死亡,總死亡率為39.06%。死亡原因主要包括:腫瘤原發(fā)灶復(fù)發(fā)2例,頸部復(fù)發(fā)21例,遠處轉(zhuǎn)移2例。其中同步放化療組死亡7例,死亡率為21.21%;單純放療組18例,死亡率為58.06%。單因素分析結(jié)果顯示:年齡、腫瘤分型、術(shù)后治療方案,有無淋巴結(jié)轉(zhuǎn)移是影響患者生存預(yù)后的因素;Cox回歸分析顯示:年齡、術(shù)后治療方案、有無淋巴結(jié)轉(zhuǎn)移是影響預(yù)后的獨立因素。結(jié)論:晚期喉癌術(shù)后同步放化療3年生存率高于術(shù)后單純放療,且不會明顯增加Ⅲ~Ⅳ級不良反應(yīng)。晚期喉癌的治療仍主要為手術(shù)切除,全喉切除術(shù)與保喉手術(shù)對患者3年生存率影響無明顯差異,可在嚴(yán)格掌握手術(shù)適應(yīng)癥的基礎(chǔ)上盡可能選擇保留喉功能的手術(shù)。同時隨訪過程中,若發(fā)現(xiàn)局部復(fù)發(fā),需及時實行挽救性全喉切除術(shù);晚期喉癌頸部淋巴結(jié)復(fù)發(fā)率較高,且為治療失敗及死亡的主因之一,因此對于術(shù)前發(fā)現(xiàn)頸部淋巴結(jié)轉(zhuǎn)移的喉癌患者,及時處理有望提高生存率;年齡、術(shù)后治療方案、有無淋巴結(jié)轉(zhuǎn)移是影響本研究晚期喉癌預(yù)后的獨立因素。
[Abstract]:Background and objective: the malignant degree of advanced laryngocarcinoma (stage III ~ IV) is higher and prone to local recurrence and distant metastasis, and the prognosis is often poor. A retrospective analysis of 64 cases of late postoperative larynx cancer in the tumor radiotherapy department of the First Affiliated Hospital of Bengbu Medical College was reviewed in this paper. The purpose of this study was to explore the two treatment schemes of postoperative concurrent chemoradiotherapy and postoperative radiotherapy alone. In the treatment of late larynx, the difference in the clinical efficacy and the recurrence and death were summarized, and the factors affecting the survival and prognosis of advanced laryngocarcinoma were analyzed. Methods: a retrospective analysis of the clinical data of 64 patients with advanced laryngeal cancer from January 2012 to December 2013 of the First Affiliated Hospital of Bengbu Medical College, including 30 cases in stage III, was analyzed. There were 34 cases in stage IV, 29 cases with supra glottis, 32 cases of glottic type, 3 cases of.33 patients with advanced laryngectomy combined with platinum based synchronous chemotherapy (synchronous radiotherapy and chemotherapy group) after operation, including 21 cases of total laryngectomy and 12 cases of laryngectomy. Only 31 cases of single pure radiotherapy (simple radiotherapy group), and 17 cases of total laryngectomy, were performed after operation. There were 14 cases of larynx. After the follow-up, 3 patients were lost, including 2 cases in concurrent chemo chemotherapy group and 1 cases in simple radiotherapy group. The follow-up rate was 95.31%. using SPSS17.0 software for data analysis. Kaplan-meier method was used to carry out survival analysis, Log-rank method was used to test, and the prognostic factor was analyzed by single factor analysis, and Cox proportional risk model was used for multiple causes. Results: the cumulative 3 year survival rate of the 64 patients was 77.7% and 50.5% in the 60.9%. synchronous radiotherapy group and the radiotherapy group, respectively. The survival rates of the two groups were statistically significant (P0.05), and there was no significant difference between the two groups of grade III ~ IV adverse reactions (P0.05), only grade III to IV The difference in the incidence of gastrointestinal tract adverse reactions was statistically significant (P0.05). It was considered that the use of chemotherapy could increase the incidence of gastrointestinal reactions in patients. The 3 year survival rate of total laryngectomy and laryngectomy was 73.1% and 54.2%, respectively, and the difference was not statistically significant (P0.05) in.64 patients with recurrence and total recurrence rate. There were 11 cases of recurrent chemotherapy in 53.13%., including 1 cases of primary recurrence, 9 cases of cervical recurrence, 1 cases of distant metastasis and 33.33% recurrence rate. 23 cases had recurrence in simple radiotherapy group, including 2 cases of primary recurrence, 18 cases of cervical recurrence, 3 cases of distant metastasis, and 25 cases of death in 74.19%.64 cases, the total mortality was 39.06%. death. The main reasons include: 2 cases of primary tumor recurrence, 21 cases of cervical recurrence and 2 cases of distant metastasis, of which 7 cases died in synchronous radiotherapy and chemotherapy group, the mortality rate was 21.21%, and 18 cases in simple radiotherapy group, the death rate of 58.06%. single factor analysis showed that age, tumor typing, postoperative treatment, lymph node metastasis were factors affecting the survival prognosis of the patients. Cox regression analysis showed that age, postoperative treatment scheme and lymph node metastasis were independent factors affecting prognosis. Conclusion: the 3 year survival rate of postoperative concurrent chemoradiotherapy for advanced laryngectomy is higher than that of postoperative radiotherapy alone, and there is no obvious increase of grade III to IV adverse reactions. The treatment of advanced laryngectomy is still mainly surgical resection, total laryngectomy and laryngectomy. There is no significant difference in the 3 year survival rate of the patients. In the course of follow-up, salvage total laryngectomy is necessary and the recurrence rate of cervical lymph nodes in late laryngectomy is high and it is one of the main causes of failure and death in the late stage of laryngectomy. Therefore, for patients with cervical lymph node metastasis before operation, the survival rate is expected to be improved in time. Age, postoperative treatment and lymph node metastasis are independent factors that affect the prognosis of late larynx cancer.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.65

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