Lee Nancy, Chan Kelvin, Bekelman Justin E, Zhung Joanne, Mechalakos James, Narayana Ashwatha, Wolden Suzanne, Venkatraman Ennapadam S, Pfister David, Kraus Dennis, Shah Jatin, Zelefsky Michael J
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Int J Radiat Oncol Biol Phys. 2007 Jul 1;68(3):731-40. doi: 10.1016/j.ijrobp.2006.12.055. Epub 2007 Mar 26.
To present a retrospective review of treatment outcomes for recurrent head and neck (HN) cancer patients treated with re-irradiation (re-RT) at a single medical center.
From July 1996-September 2005, 105 patients with recurrent HN cancer underwent re-RT at our institution. Sites included were: the neck (n = 21), nasopharynx (n = 21), paranasal sinus (n = 18), oropharynx (n = 16), oral cavity (n = 9), larynx (n = 10), parotid (n = 6), and hypopharynx (n = 4). The median prior RT dose was 62 Gy. Seventy-five patients received chemotherapy with their re-RT (platinum-based in the majority of cases). The median re-RT dose was 59.4 Gy. In 74 (70%), re-RT utilized intensity-modulated radiation therapy (IMRT).
With a median follow-up of 35 months, 18 patients were alive with no evidence of disease. The 2-year loco-regional progression-free survival (LRPFS) and overall survival rates were 42% and 37%, respectively. Patients who underwent IMRT, compared to those who did not, had a better 2-year LRPF (52% vs. 20%, p < 0.001). On multivariate analysis, non-nasopharynx and non-IMRT were associated with an increased risk of loco-regional (LR) failure. Patients with LR progression-free disease had better 2-year overall survival vs. those with LR failure (56% vs. 21%, p < 0.001). Acute and late Grade 3-4 toxicities were reported in 23% and 15% of patients. Severe Grade 3-4 late complications were observed in 12 patients, with a median time to development of 6 months after re-RT.
Based on our data, achieving LR control is crucial for improved overall survival in this patient population. The use of IMRT predicted better LR tumor control. Future aggressive efforts in maximizing tumor control in the recurrent setting, including dose escalation with IMRT and improved chemotherapy, are warranted.
对在单一医疗中心接受再照射（再放疗）治疗的复发性头颈部（HN）癌患者的治疗结果进行回顾性分析。
1996年7月至2005年9月，105例复发性HN癌患者在我院接受了再放疗。受累部位包括：颈部（n = 21）、鼻咽（n = 21）、鼻窦（n = 18）、口咽（n = 16）、口腔（n = 9）、喉（n = 10）、腮腺（n = 6）和下咽（n = 4）。既往放疗的中位剂量为62 Gy。75例患者在再放疗时接受了化疗（大多数病例为铂类化疗）。再放疗的中位剂量为59.4 Gy。74例（70%）患者采用调强放射治疗（IMRT）进行再放疗。
中位随访35个月，18例患者存活且无疾病证据。2年局部区域无进展生存率（LRPFS）和总生存率分别为42%和37%。接受IMRT的患者与未接受IMRT的患者相比，2年LRPFS更好（52%对20%，p < 0.001）。多因素分析显示，非鼻咽和非IMRT与局部区域（LR）失败风险增加相关。LR无进展疾病的患者与LR失败的患者相比，2年总生存率更好（56%对21%，p < 0.001）。23%和15%的患者报告了3 - 4级急性和晚期毒性反应。12例患者观察到严重的3 - 4级晚期并发症，再放疗后发生的中位时间为6个月。
根据我们的数据，实现LR控制对于改善该患者群体的总生存率至关重要。IMRT的使用预示着更好的LR肿瘤控制。未来有必要积极努力，在复发情况下最大限度地控制肿瘤，包括采用IMRT进行剂量递增和改进化疗。
