Lee Nancy Y, O'Meara William, Chan Kelvin, Della-Bianca Cesar, Mechalakos James G, Zhung Joanne, Wolden Suzanne L, Narayana Ashwatha, Kraus Dennis, Shah Jatin P, Pfister David G
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):459-68. doi: 10.1016/j.ijrobp.2007.03.013. Epub 2007 May 9.
To perform a retrospective review of laryngeal/hypopharyngeal carcinomas treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT).
Between January 2002 and June 2005, 20 laryngeal and 11 hypopharyngeal carcinoma patients underwent IMRT with concurrent platinum-based chemotherapy; most patients had Stage IV disease. The prescription of the planning target volume for gross, high-risk, and low-risk subclinical disease was 70, 59.4, and 54 Gy, respectively. Acute/late toxicities were retrospectively scored using the Common Toxicity Criteria scale. The 2-year local progression-free, regional progression-free, laryngectomy-free, distant metastasis-free, and overall survival rates were calculated using the Kaplan-Meier method.
The median follow-up of the living patients was 26 months (range, 17-58 months). The 2-year local progression-free, regional progression-free, laryngectomy-free, distant metastasis-free, and overall survival rate was 86%, 94%, 89%, 92%, and 63%, respectively. Grade 2 mucositis or higher occurred in 48% of patients, and all experienced Grade 2 or higher pharyngitis during treatment. Xerostomia continued to decrease over time from the end of RT, with none complaining of Grade 2 toxicity at this analysis. The 2-year post-treatment percutaneous endoscopic gastrostomy-dependency rate for those with hypopharyngeal and laryngeal tumors was 31% and 15%, respectively. The most severe late complications were laryngeal necrosis, necrotizing fascitis, and a carotid rupture resulting in death 3 weeks after salvage laryngectomy.
These preliminary results have shown that IMRT achieved encouraging locoregional control of locoregionally advanced laryngeal and hypopharyngeal carcinomas. Xerostomia improved over time. Pharyngoesophageal stricture with percutaneous endoscopic gastrostomy dependency remains a problem, particularly for patients with hypopharyngeal carcinoma and, to a lesser extent, those with laryngeal cancer. Strategies using IMRT to limit the dose delivered to the esophagus/inferior constrictor musculature without compromising target coverage might be useful to further minimize this late complication.
对采用同步化疗和调强放射治疗（IMRT）的喉癌/下咽癌患者进行回顾性研究。
2002年1月至2005年6月期间，20例喉癌和11例下咽癌患者接受了IMRT同步铂类化疗；大多数患者为IV期疾病。大体肿瘤、高危和低危亚临床疾病的计划靶体积处方剂量分别为70、59.4和54 Gy。采用通用毒性标准量表对急性/晚期毒性进行回顾性评分。采用Kaplan-Meier法计算2年局部无进展、区域无进展、无喉切除术、无远处转移和总生存率。
存活患者的中位随访时间为26个月（范围17 - 58个月）。2年局部无进展、区域无进展、无喉切除术、无远处转移和总生存率分别为86%、94%、89%、92%和63%。48%的患者发生2级或更高等级的黏膜炎，所有患者在治疗期间均经历2级或更高等级的咽炎。口干从放疗结束后随时间持续减轻，在此分析中无患者主诉2级毒性。下咽癌和喉癌患者治疗后2年经皮内镜下胃造口术依赖率分别为31%和15%。最严重的晚期并发症是喉坏死、坏死性筋膜炎以及一例在挽救性喉切除术后3周因颈动脉破裂导致死亡。
这些初步结果表明，IMRT在局部区域晚期喉癌和下咽癌的局部区域控制方面取得了令人鼓舞的效果。口干随时间有所改善。伴有经皮内镜下胃造口术依赖的咽食管狭窄仍然是一个问题，尤其是在下咽癌患者中，在较小程度上也存在于喉癌患者中。采用IMRT在不影响靶区覆盖的情况下限制输送至食管/下咽缩肌的剂量的策略，可能有助于进一步减少这种晚期并发症。
