Allal Abdelkarim S, Taussky Daniel, Mach Nicolas, Becker Minerva, Bieri Sabine, Dulguerov Pavel
Division of Radiation Oncology, University Hospital of Geneva, Geneva, Switzerland.
Int J Radiat Oncol Biol Phys. 2004 Apr 1;58(5):1431-6. doi: 10.1016/j.ijrobp.2003.09.017.
Accelerated schedules are effective in overcoming repopulation during radiotherapy (RT) for head-and-neck cancers, but their feasibility is compromised by increased toxicity. The therapeutic ratio may be particularly favorable for 5-week regimens. This study reports the 10-year experience of a single institution in the routine use of concomitant boost RT as standard radical treatment in all but the most favorable stage patients.
Between February 1991 and June 2001, 296 patients (mean age, 59 years) were treated with concomitant boost RT either alone (67%) or combined with cisplatin-based chemotherapy (33%), with a median tumor dose of 69.9 Gy. Tumors were located in the oropharynx in 52%, hypopharynx in 20%, larynx in 15%, nasopharynx in 7%, and oral cavity in 6%. International Union Against Cancer Stage III-IV disease represented 77% of tumors. The median follow-up for surviving patients was 55 months (range, 10-138 months).
The RT schedule was completed to the prescribed dose in all but 1 patient. Twenty patients (7%) had a treatment interruption (median, 5 days; range, 2-35 days). Grade 3-4 Radiation Therapy Oncology Group acute toxicity was observed in 77% of patients, and nutritional support was required in 110 patients (37%). For all patients, the 5-year actuarial locoregional control and disease-free survival rate was 72% and 61%, respectively. In a multivariate analysis, only T and N stage was significantly associated with locoregional control and disease-free survival. Grade 3-4 late toxicity occurred in 14%, mostly bone and cartilage necrosis.
The present, moderately accelerated, concomitant boost regimen is logistically feasible, causing minimal inconvenience to the technical staff and yielding a high rate of patient compliance. Concomitant chemotherapy administration is feasible provided that patients are carefully selected and supportive care is introduced in a timely fashion. Considering the manageable toxicity and the satisfactory tumor control obtained, this regimen represents a good choice when considering implementation of an altered RT fractionation schedule as standard treatment for head-and-neck cancers.
加速放疗方案在克服头颈癌放疗（RT）期间的再增殖方面是有效的，但其可行性因毒性增加而受到影响。治疗比对于5周疗程可能特别有利。本研究报告了单一机构在除最有利分期患者外的所有患者中常规使用同步推量放疗作为标准根治性治疗的10年经验。
在1991年2月至2001年6月期间，296例患者（平均年龄59岁）接受了同步推量放疗，单独放疗（67%）或联合基于顺铂的化疗（33%），中位肿瘤剂量为69.9 Gy。肿瘤位于口咽的占52%，下咽的占20%，喉的占15%，鼻咽的占7%，口腔的占6%。国际抗癌联盟III-IV期疾病占肿瘤的77%。存活患者的中位随访时间为55个月（范围10 - 138个月）。
除1例患者外，所有患者均完成了规定剂量的放疗计划。20例患者（7%）出现治疗中断（中位时间5天；范围2 - 35天）。77%的患者观察到3 - 4级放射治疗肿瘤学组急性毒性，110例患者（37%）需要营养支持。所有患者的5年精算局部区域控制率和无病生存率分别为72%和61%。在多因素分析中，只有T和N分期与局部区域控制和无病生存显著相关。14%的患者出现3 - 4级晚期毒性，主要是骨和软骨坏死。
目前这种适度加速的同步推量方案在后勤方面是可行的，给技术人员带来的不便最小，患者依从率高。只要仔细选择患者并及时引入支持治疗，同步化疗给药是可行的。考虑到可管理的毒性和获得的令人满意的肿瘤控制，当考虑将改变的放疗分割方案作为头颈癌的标准治疗实施时，该方案是一个不错的选择。
