Wolden Suzanne L, Wexler Leonard H, Kraus Dennis H, Laquaglia Michael P, Lis Eric, Meyers Paul A
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Int J Radiat Oncol Biol Phys. 2005 Apr 1;61(5):1432-8. doi: 10.1016/j.ijrobp.2004.08.005.
To determine the preliminary results of intensity-modulated radiotherapy (IMRT) for head-and-neck rhabdomyosarcoma.
Twenty-eight patients underwent IMRT as a part of multimodality therapy. Twenty-one tumors were parameningeal, three were orbital, and four were in other sites. The median age was 8 years (range, 1-29 years). Most (89%) had Group III disease. Intracranial extension was present in 71% of parameningeal tumors. A 1.5-cm margin was used, and the median dose was 50.4 Gy (range, 30-55.8 Gy).
The actuarial 3-year survival rate for patients with parameningeal tumors was 65%. The 3-year actuarial freedom from failure rate was 95% locally, 90% in regional nodes, 88% in the central nervous system, and 80% at distant sites. No failures occurred among patients with orbit tumors; a single central nervous system failure occurred in 1 patient with a lip/cheek tumor. Disease-free survival was significantly worse for patients with alveolar histologic features (p = 0.01). Acute radiation toxicity was similar to that reported by the Intergroup Rhabdomyosarcoma Study Group. Late radiation toxicity was recorded and was mild.
IMRT with image fusion results in outstanding local control despite the use of a reduced margin. However, survival among patients with alveolar histologic findings or intracranial extension remains unacceptably low.
确定调强放射治疗（IMRT）用于头颈部横纹肌肉瘤的初步结果。
28例患者接受IMRT作为多模式治疗的一部分。21例肿瘤位于脑膜旁，3例位于眼眶，4例位于其他部位。中位年龄为8岁（范围1 - 29岁）。大多数（89%）为III期疾病。71%的脑膜旁肿瘤存在颅内侵犯。采用1.5厘米的边界，中位剂量为50.4 Gy（范围30 - 55.8 Gy）。
脑膜旁肿瘤患者的3年精算生存率为65%。3年精算无失败生存率在局部为95%，区域淋巴结为90%，中枢神经系统为88%，远处部位为80%。眼眶肿瘤患者未发生失败；1例唇/颊部肿瘤患者发生1次中枢神经系统失败。具有肺泡组织学特征的患者无病生存率显著更差（p = 0.01）。急性放射毒性与横纹肌肉瘤协作组研究报道的相似。记录到晚期放射毒性且较轻。
尽管使用了缩小的边界，但图像融合的IMRT仍能实现出色的局部控制。然而，具有肺泡组织学表现或颅内侵犯的患者生存率仍低得令人无法接受。
