Pameijer F A, Hermans R, Mancuso A A, Mendenhall W M, Parsons J T, Stringer S P, Kubilis P S, van Tinteren H
Department of Radiology, University of Florida College of Medicine, Gainesville, USA.
Int J Radiat Oncol Biol Phys. 1999 Sep 1;45(2):359-66. doi: 10.1016/s0360-3016(99)00149-2.
To determine if pre-radiotherapy (RT) and/or post-radiotherapy computed tomography (CT) can predict local failure in patients with laryngeal carcinoma treated with definitive RT.
The pre- and post-RT CT examinations of 59 patients (T3 glottic carcinoma [n = 30] and T1-T4 supraglottic carcinoma [n = 29]) were reviewed. For each patient, the first post-RT CT study between 1 and 6 months after irradiation was used. All patients were treated with definitive hyperfractionated twice-daily continuous-course irradiation to a total dose of 6,720-7,920 cGy, and followed-up clinically for at least 2 years after completion of RT. Local control was defined as absence of primary tumor recurrence and a functioning larynx. On the pre-treatment CT study, each tumor was assigned a high-or low-risk profile for local failure after RT. The post-RT CT examinations were evaluated for post-treatment changes using a three-point post-RT CT-score: 1 = expected post-RT changes; 2 = focal mass with a maximal diameter of < 1 cm and/or asymmetric obliteration of laryngeal tissue planes; 3 = focal mass with a maximal diameter of > 1 cm, or < 50% estimated tumor volume reduction.
The local control rates at 2 years post-RT based on pre-treatment CT evaluation were 88% for low pre-treatment risk profile patients (95% CI: 66-96%) and 34% (95% CI: 19-50%) for high pre-treatment risk profile patients (risk ratio 6.583; 95% CI: 2.265-9.129;p = 0.0001). Based on post-treatment CT, the local control rates at 2 years post-RT were 94% for score 1, 67% for score 2, and 10% for score 3 (risk ratio 4.760; 95% CI: 2.278-9.950 p = 0.0001). Post-RT CT scores added significant information to the pre-treatment risk profiles on prognosis.
Pre-treatment CT risk profiles, as well as post-RT CT evaluation can identify patients, irradiated for laryngeal carcinomas, at high risk for developing local failure. When the post-RT CT score is available, it proves to be an even better prognosticator than the pre-treatment CT-risk profile.
确定放疗前和/或放疗后计算机断层扫描（CT）能否预测接受根治性放疗的喉癌患者的局部失败情况。
回顾了59例患者（30例声门型T3期癌和29例声门上型T1-T4期癌）放疗前和放疗后的CT检查。对于每位患者，采用放疗后1至6个月内的首次CT检查。所有患者均接受根治性超分割每日两次连续疗程放疗，总剂量为6720-7920 cGy，放疗结束后临床随访至少2年。局部控制定义为无原发肿瘤复发且喉部功能正常。在治疗前的CT检查中，为每个肿瘤指定放疗后局部失败的高风险或低风险特征。使用放疗后CT三分评分对放疗后的CT检查进行治疗后变化评估：1 = 放疗后预期变化；2 = 最大直径<1 cm的局灶性肿块和/或喉部组织平面的不对称闭塞；3 = 最大直径>1 cm的局灶性肿块，或估计肿瘤体积缩小<50%。
根据治疗前CT评估，放疗后2年低治疗前风险特征患者的局部控制率为88%（95%CI：66-96%），高治疗前风险特征患者为34%（95%CI：19-50%）（风险比6.583；95%CI：2.265-9.129；p = 0.0001）。根据放疗后CT，放疗后2年1分患者的局部控制率为94%，2分患者为67%，3分患者为10%（风险比4.760；95%CI：2.278-9.950；p = 0.0001）。放疗后CT评分在预后方面为治疗前风险特征增加了重要信息。
治疗前CT风险特征以及放疗后CT评估能够识别接受喉癌放疗的高局部失败风险患者。当有放疗后CT评分时，它被证明是比治疗前CT风险特征更好的预后指标。
