Studer Gabriela, Lütolf Urs Martin, Davis Jacques Bernard, Glanzmann Christoph
Radiotherapie, USZ, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
Strahlenther Onkol. 2006 Jun;182(6):331-5. doi: 10.1007/s00066-006-1556-2.
Intensity-modulated radiation therapy (IMRT) data on hypopharyngeal cancer (HC) are scant. In this study, the authors report on early results in an own HC patient cohort treated with IMRT. A more favorable outcome as compared to historical data on conventional radiation techniques was expected.
29 consecutive HC patients were treated with simultaneous integrated boost (SIB) IMRT between 01/2002 and 07/2005 (mean follow-up 16 months, range 4-44 months). Doses of 60-71 Gy with 2.0-2.2 Gy/fraction were applied. 26/29 patients were definitively irradiated, 86% received simultaneous cisplatin-based chemotherapy. 60% presented with locally advanced disease (T3/4 Nx, Tx N2c/3). Mean primary tumor volume measured 36.2 cm(3) (4-170 cm(3)), mean nodal volume 16.6 cm(3) (0-97 cm(3)).
2-year actuarial local, nodal, distant control, and overall disease-free survival were 90%, 93%, 93%, and 90%, respectively. In 2/4 patients with persistent disease (nodal in one, primary in three), salvage surgery was performed. The mean dose to the spinal cord (extension of > 5-15 mm) was 26 Gy (12-38 Gy); the mean maximum (point) dose was 44.4 Gy (26-58.9 Gy). One grade (G) 3 dysphagia and two G4 reactions (laryngeal fibrosis, dysphagia), both following the schedule with 2.2 Gy per fraction, have been observed so far. Larynx preservation was achieved in 25/26 of the definitively irradiated patients (one underwent a salvage laryngectomy); 23 had no or minimal dysphagia (G0-1).
Excellent early disease control and high patient satisfaction with swallowing function in HC following SIB IMRT were observed; these results need to be confirmed based on a longer follow-up period. In order to avoid G4 reactions, SIB doses of < 2.2 Gy/fraction are recommended for large tumors involving laryngeal structures.
下咽癌（HC）的调强放射治疗（IMRT）数据较少。在本研究中，作者报告了一组接受IMRT治疗的下咽癌患者的早期结果。预计与传统放射技术的历史数据相比，会有更理想的结果。
2002年1月至2005年7月期间，连续29例下咽癌患者接受了同步整合加量（SIB）IMRT治疗（平均随访16个月，范围4 - 44个月）。给予的剂量为60 - 71 Gy，每次分割剂量为2.0 - 2.2 Gy。29例患者中有26例接受根治性放疗，86%的患者同时接受了以顺铂为基础的化疗。60%的患者表现为局部晚期疾病（T3/4 Nx，Tx N2c/3）。原发肿瘤平均体积为36.2 cm³（4 - 170 cm³），淋巴结平均体积为16.6 cm³（0 - 97 cm³）。
2年精算局部、区域、远处控制及总体无病生存率分别为90%、93%、93%和90%。在4例疾病持续存在的患者中（1例为区域淋巴结，3例为原发灶），有2例接受了挽救性手术。脊髓（延伸长度>5 - 15 mm）的平均剂量为26 Gy（12 - 38 Gy）；平均最大（点）剂量为44.4 Gy（26 - 58.9 Gy）。目前观察到1例3级吞咽困难和2例4级反应（喉纤维化、吞咽困难），均发生在每次分割剂量为2.2 Gy的治疗方案之后。26例接受根治性放疗的患者中有25例实现了喉保留（1例接受了挽救性喉切除术）；23例患者无吞咽困难或吞咽困难轻微（0 - 1级）。
观察到同步整合加量IMRT治疗下咽癌后早期疾病控制良好，患者对吞咽功能满意度高；这些结果需要更长的随访期来证实。为避免4级反应，对于累及喉部结构的大肿瘤，建议同步整合加量剂量<2.2 Gy/次分割。
