Allal A S, Monney M, Rosset A, Ozsahin M, Guillemin C
Division of Radiation Oncology, University Hospital of Geneva, Switzerland.
Strahlenther Onkol. 2000 Jan;176(1):28-31. doi: 10.1007/pl00002301.
Accelerated radiotherapy delivery has recently been shown to be effective in overcoming repopulation during fractionated radiotherapy. The therapeutic ratio may be particularly favorable for 5-week regimens. This study reports the feasibility and results of a particular accelerated schedule in Stage III to IV head and neck carcinomas used in a multicenter setting.
Seventy-four patients with Stage III (26 patients) or IV (48 patients) head and neck carcinomas were treated with a 5-week accelerated schedule (69.6 to 69.8 Gy in 41 to 40 fractions over a period of 35 to 36 days). Treatment began with 20 Gy in 10 daily fractions to initial involved sites, followed by bi-fractionated radiotherapy (2 x 1.6 Gy to 1.66 Gy/day) to a larger head and neck volume. Thirty-six (49%) patients received induction chemotherapy (median 3 cycles, range 1 to 4 cycles).
Grade 3 or 4 (RTOG) confluent mucositis was observed in 57 patients (77%) and Grade 3 dysphagia in 33 patients (44%). Grade 3 or 4 (RTOG-EORTC) late complications were scored in 10.5% of cases. The 5-year actuarial locoregional control rate was 56% (95% CI: 42 to 71). The 5-year overall actuarial survival was 32% (95% CI: 18 to 46). Induction chemotherapy was not associated with a more favorable outcome.
This study demonstrates the feasibility of this schedule in a multicenter setting. The oncologic results appear similar to those obtained by other accelerated regimens, while the rate of late complications seems acceptable. Five-week accelerated regimens warrant further evaluation, particularly in conjunction with concomitant chemotherapy, in the framework of prospective trials.
最近研究表明，在分次放疗期间，加速放疗方案在克服肿瘤再增殖方面是有效的。对于5周的放疗方案，治疗增益比可能特别有利。本研究报告了在多中心环境下，针对III期至IV期头颈癌采用的一种特定加速放疗方案的可行性和结果。
74例III期（26例）或IV期（48例）头颈癌患者接受了为期5周的加速放疗方案（在35至36天内分41至40次给予69.6至69.8 Gy）。治疗开始时，对初始受累部位每天分10次给予20 Gy，随后对更大的头颈区域进行双分次放疗（每天2次，每次1.6 Gy至1.66 Gy）。36例（49%）患者接受了诱导化疗（中位3个周期，范围1至4个周期）。
57例患者（77%）出现3级或4级（RTOG）融合性黏膜炎，33例患者（44%）出现3级吞咽困难。10.5%的病例出现3级或4级（RTOG-EORTC）晚期并发症。5年精算局部区域控制率为56%（95%CI：42至71）。5年总精算生存率为32%（95%CI：18至46）。诱导化疗与更优的预后无关。
本研究证明了该方案在多中心环境下的可行性。肿瘤学结果似乎与其他加速放疗方案相似，而晚期并发症发生率似乎可以接受。5周加速放疗方案值得进一步评估，尤其是在前瞻性试验框架内与同步化疗联合使用时。
