頸部転移陰性舌癌の治療と予後

Therapy and Prognosis of Carcinoma of the Tongue without Neck Metastasis

　はじめに

　舌癌の治療で苦慮するのは原発巣よりも頸部転移に対してであることが多く，頸部転移の有無は予後を大きく左右する因子であることは既に報告されている。一方，一次治療時に頸部転移を有さず，原発巣の根治治療を行い得た症例の予後が非常に良好であるかと問われると，そうとも言い切れず，このような症例に対する治療法に決定的なものがないのが実状である。

　今回われわれは一次治療時に頸部転移を有さなかった舌癌，頸部転移陰性舌癌に注目し，その治療と予後を検討し，このような頸部転移陰性舌癌の治療法について当科の答えを求め，ひいては舌癌の治療成績を向上させ得る治療方針を確立するべく，若干の文献的考察を加えて報告する。

Clinicostatistical study was made in 78 cases with tongue cancer without cervical metastases who were recieved therapy between 1975 and 1992. The 5 -year survival rate with Kaplan-Meier statistics of 78 cases was 70.7%, and this was better than that of 34 cases with cervical metastases. Primary recur-rence after initial therapy was noted in 14 cases, and cervical recurrence without primary recurrence wasfound in 11 cases. No recurrences in both primary and cervical regions were noted in 12 cases who were received surgical resection and prophylactic neck dissection. The 5-year survival rate of cases who received prophylactic neck dissection was 83.3%, and this was better than that of cases with-out prophylactic dissection.

Up to date, irradiation with intra-arterial chemo-therapy in carcinoma of the tongue and therapeutic neck dissection was performed in our department. Late cervical metastases after initial treatment were observed in 11 cases.

According to the results, prophylactic neck dissec-tion should be considered especially in T3, T4 tumors, and in T2 tumors resistant to irradiation with intara -arterial chemotherapy.