Chen Yi-Jen, Kuo Jeffrey V, Ramsinghani Nilam S, Al-Ghazi Muthana S A L
Department of Radiation Oncology, University of California Irvine Medical Center, Orange 92868, USA.
Med Dosim. 2002 Summer;27(2):171-6. doi: 10.1016/s0958-3947(02)00100-0.
The purpose of this work is to evaluate our initial experience in treating previously irradiated, recurrent head-and-neck cancers using intensity-modulated radiotherapy (IMRT). Between July 1997 and September 1999, 12 patients with previously irradiated, locally recurrent head-and-neck cancers were treated with IMRT. These included cancers of the nasopharynx, oropharynx, hypopharynx, larynx, paranasal sinus, skin of the head-and-neck region, and malignant melanoma. Five of these 12 patients had received radiation as the primary treatment, with doses ranging from 66.0 to 126.0 Gy, and the remaining 7 patients had undergone definitive surgeries followed by an adjuvant course of radiation treatment, with doses ranging between 36.0 and 64.8 Gy. Recurrence after the initial course of radiation occurred in periods ranging from 4 to 35 months, with 11 of 12 cases recurring fully in the fields of previous irradiation. Recurrent tumors were treated with IMRT to total doses between 30 to 70 Gy (> 50 Gy in 10 cases) prescribed at the 75% to 92% isodose lines with daily fractions of 1.8 to 2 Gy. The results revealed that acute toxicities were acceptable except in 1 patient who died of aspiration pneumonia during the course of retreatment. There were 4 complete responders, 2 partial responders, and 2 patients with stable disease in the IMRT-treated volumes. Three patients received IMRT as adjuvant treatment following salvage surgery. At 4 to 16 months of follow-up, 7 patients were still alive, with 5 revealing no evidence of disease. In conclusion, this pilot study demonstrates that IMRT offers a viable mode of re-irradiation for recurrent head-and-neck cancers in previously irradiated sites. Longer follow-up time and a larger number of patients are needed to better define the therapeutic advantage of IMRT in recurrent, previously irradiated head-and-neck cancers.
本研究旨在评估我们使用调强放射治疗（IMRT）治疗既往接受过放疗的复发性头颈癌的初步经验。1997年7月至1999年9月期间，12例既往接受过放疗的局部复发性头颈癌患者接受了IMRT治疗。这些癌症包括鼻咽癌、口咽癌、下咽癌、喉癌、鼻窦癌、头颈区域皮肤癌和恶性黑色素瘤。这12例患者中有5例曾接受过放疗作为主要治疗，剂量范围为66.0至126.0 Gy，其余7例患者接受了根治性手术，随后进行辅助放疗，剂量范围为36.0至64.8 Gy。初始放疗疗程后复发时间为4至35个月，12例中有11例在既往放疗野内完全复发。复发性肿瘤接受IMRT治疗，总剂量为30至70 Gy（10例超过50 Gy），处方剂量在75%至92%等剂量线，每日分次剂量为1.8至2 Gy。结果显示，除1例患者在再治疗过程中死于吸入性肺炎外，急性毒性反应均可接受。在接受IMRT治疗的区域，有4例完全缓解者，2例部分缓解者，2例病情稳定。3例患者在挽救性手术后接受IMRT作为辅助治疗。在4至16个月的随访中，7例患者仍存活，5例无疾病证据。总之，这项初步研究表明，IMRT为既往放疗部位的复发性头颈癌提供了一种可行的再照射模式。需要更长的随访时间和更多的患者来更好地确定IMRT在复发性、既往接受过放疗的头颈癌中的治疗优势。
