Terhaard Chris H J, Lubsen Herman, Rasch Coen R N, Levendag Peter C, Kaanders Hans H A M, Tjho-Heslinga Reineke E, van Den Ende Piet L A, Burlage Fred
Department of Radiotherapy, University Medical Center, Utrecht, The Netherlands.
Int J Radiat Oncol Biol Phys. 2005 Jan 1;61(1):103-11. doi: 10.1016/j.ijrobp.2004.03.018.
We analyzed the role of primary and postoperative low linear energy transfer radiotherapy in 538 patients treated for salivary gland cancer in centers of the Dutch Head and Neck Oncology Cooperative Group, in search for prognostic factors and dose response.
The tumor was located in the parotid gland in 59%, submandibular gland in 14%, oral cavity in 23%, and elsewhere in 5%. In 386 of 498 patients surgery was combined with radiotherapy, with a median dose of 62 Gy. Median delay between surgery and radiotherapy was 6 weeks. In the postoperative radiotherapy group, adverse prognostic factors prevailed. Elective radiotherapy to the neck was given in 40%, with a median dose of 50 Gy. Primary radiotherapy (n = 40) was given for unresectable disease or M(1), with a dose range of 28-74 Gy.
Postoperative radiotherapy improved 10-year local control significantly compared with surgery alone in T(3-4) tumors (84% vs. 18%), in patients with close (95% vs. 55%) and incomplete resection (82% vs. 44%), in bone invasion (86% vs. 54%), and perineural invasion (88% vs. 60%). Local control was not correlated with interval between surgery and radiotherapy. No dose-response relationship was shown. Postoperative radiotherapy significantly improved regional control in the pN(+) neck (86% vs. 62% for surgery alone). A rating scale for different sites, T stage, and histologic type may be applied to calculate the risk of disease in the neck at presentation, and so indicate the need for elective neck treatment. A marginal dose-response was seen, in favor of a dose > or =46 Gy. A clear dose-response relationship was shown for patients treated with primary radiotherapy. Five-year local control was 50% with a dose of 66-70 Gy.
Postoperative radiotherapy with a dose of at least 60 Gy is indicated for patients with T(3-4) tumors, incomplete or close resection, bone invasion, perineural invasion, and pN(+). In unresectable tumors, a dose of at least 66 Gy is advisable.
我们分析了荷兰头颈肿瘤协作组各中心治疗的538例涎腺癌患者中，术前及术后低线性能量传递放疗的作用，以寻找预后因素和剂量反应关系。
肿瘤位于腮腺的占59%，下颌下腺的占14%，口腔的占23%，其他部位的占5%。498例患者中有386例手术联合放疗，中位剂量为62 Gy。手术与放疗的中位间隔时间为6周。术后放疗组中，不良预后因素更为常见。40%的患者接受了颈部选择性放疗，中位剂量为50 Gy。对无法切除的疾病或M(1)期患者进行了术前放疗（n = 40），剂量范围为28 - 74 Gy。
与单纯手术相比，术后放疗在T(3 - 4)期肿瘤患者（84%对18%）、切缘阳性（95%对55%）和切除不完全（82%对44%）、有骨侵犯（86%对54%）以及有神经周围侵犯（88%对60%）的患者中，显著提高了10年局部控制率。局部控制率与手术和放疗之间的间隔时间无关。未显示剂量反应关系。术后放疗显著提高了pN(+)颈部的区域控制率（86%对单纯手术的62%）。可应用针对不同部位、T分期和组织学类型的评分量表来计算初诊时颈部疾病的风险，从而表明是否需要进行选择性颈部治疗。观察到一种边缘剂量反应，倾向于剂量≥46 Gy。对于接受术前放疗的患者，显示出明确的剂量反应关系。剂量为66 - 70 Gy时，5年局部控制率为50%。
对于T(3 - 4)期肿瘤、切除不完全或切缘阳性、有骨侵犯、有神经周围侵犯以及pN(+)的患者，建议进行至少60 Gy的术后放疗。对于无法切除的肿瘤，建议至少给予66 Gy的剂量。
