Bristol Ian J, Ahamad Anesa, Garden Adam S, Morrison William H, Hanna Ehab Y, Papadimitrakopoulou Vassiliki A, Rosenthal David I, Ang K Kian
Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2007 Jul 1;68(3):719-30. doi: 10.1016/j.ijrobp.2007.01.032.
To determine the effects of three changes in radiotherapy technique on the outcomes for patients irradiated postoperatively for maxillary sinus cancer.
The data of 146 patients treated between 1969 and 2002 were reviewed. The patients were separated into two groups according to the date of treatment. Group 1 included 90 patients treated before 1991 and Group 2 included 56 patients treated after 1991, when the three changes were implemented. The outcomes were compared between the two groups.
No differences were found in the 5-year overall survival, recurrence-free survival, local control, nodal control, or distant metastasis rates between the two groups (51% vs. 62%, 51% vs. 57%, 76% vs. 70%, 82% vs. 83%, and 28% vs. 17% for Groups 1 and 2, respectively). The three changes were to increase the portals to cover the base of the skull in patients with perineural invasion, reducing their risk of local recurrence; the addition of elective neck irradiation in patients with squamous or undifferentiated histologic features, improving the nodal control, distant metastasis, and recurrence-free survival rates (64% vs. 93%, 20% vs. 3%, and 45% vs. 67%, respectively; p < 0.05 for all comparisons); and improving the dose distributions within the target volume, reducing the late Grade 3-4 complication rates (34% in Group 1 vs. 8% in Group 2, p = 0.014). Multivariate analysis revealed advancing age, the need for enucleation, and positive margins as independent predictors of worse overall survival. The need for enucleation also predicted for worse local control.
The three changes in radiotherapy technique improved the outcomes for select patients as predicted. Despite these changes, little demonstrable overall improvement occurred in local control or survival for these patients and additional work must be done.
确定三种放射治疗技术的改变对术后接受放疗的上颌窦癌患者预后的影响。
回顾了1969年至2002年间接受治疗的146例患者的数据。根据治疗日期将患者分为两组。第1组包括90例1991年前接受治疗的患者，第2组包括56例1991年后接受治疗的患者，1991年后实施了这三种改变。比较两组的预后。
两组在5年总生存率、无复发生存率、局部控制率、区域淋巴结控制率或远处转移率方面均未发现差异（第1组和第2组分别为51%对62%、51%对57%、76%对70%、82%对83%和28%对17%）。这三种改变分别是：对于有神经周围侵犯的患者，扩大照射野以覆盖颅底，降低局部复发风险；对于具有鳞状或未分化组织学特征的患者，增加选择性颈部照射，提高区域淋巴结控制率、远处转移率和无复发生存率（分别为64%对93%、20%对3%和45%对67%；所有比较的p<0.05）；以及改善靶区内的剂量分布，降低3-4级晚期并发症发生率（第1组为34%，第2组为8%，p = 0.014）。多因素分析显示，年龄增长、需要眼球摘除术以及手术切缘阳性是总生存较差的独立预测因素。需要眼球摘除术也预示着局部控制较差。
如预期的那样，放射治疗技术的这三种改变改善了部分患者的预后。尽管有这些改变，但这些患者在局部控制或生存方面几乎没有明显的总体改善，仍需开展更多工作。
