Guerrero Urbano Teresa, Clark Catharine H, Hansen Vibeke N, Adams Elizabeth J, A'Hern Roger, Miles Elizabeth A, McNair Helen, Bidmead Margaret, Warrington Alan P, Dearnaley David P, Harrington Kevin J, Nutting Christopher M
Head and Neck Unit, Royal Marsden Hospital, Surrey, UK.
Radiother Oncol. 2007 Oct;85(1):36-41. doi: 10.1016/j.radonc.2007.07.011. Epub 2007 Aug 20.
Intensity modulated radiotherapy (IMRT) allows the delivery of higher and more homogeneous radiation dose to head and neck tumours. This study aims to determine the safety of dose-escalated chemo-IMRT for larynx preservation in locally advanced head and neck cancer.
Patients with T2-4, N1-3, M0 squamous cell carcinoma of the larynx or hypopharynx were treated with a simultaneous-boost IMRT. Two radiation dose levels (DL) were tested: In DL 1, 63 Gy/28F was delivered to primary tumour and involved nodes and 51.8 Gy/28F to elective nodes. In DL 2, the doses were 67.2 Gy/28F and 56 Gy/28F, respectively, representing a 9% dose escalation for the primary. All patients received 2 cycles of neoadjuvant cisplatin and 5-fluorouracil, and concomitant cisplatin. Acute (NCICTCv.2.0) and late toxicity (RTOG and modified LENTSOM) were collected.
Thirty patients were entered, 15 in each dose level. All patients completed the treatment schedule. In DL 1, the incidences of acute G3 toxicities were 27% (pain), 20% (radiation dermatitis), 0% (xerostomia) and 67% required gastrostomy tubes. For DL 2 the corresponding incidences were 40%, 20%, 7%, and 87%. G3 dysphagia and pain persisted longer in DL 2. With regard to mucositis, a prolonged healing time for DL 2 was found, with prevalence of G2 of 58% in week 10. No acute grade 4 toxicity was observed. At 6 months, 1 patient in DL 2 had G3 late toxicity (dysphagia). No dose limiting toxicity was found. Complete response rates were 80% in DL 1, and 87% in DL 2.
Moderately accelerated chemo-IMRT is safe and feasible with good compliance and acceptable acute toxicity. Dose escalation was possible without a significant difference in acute toxicity. Longer follow-up is required to determine the incidence of late radiation toxicities, and tumour control rates.
调强放射治疗（IMRT）能够向头颈部肿瘤输送更高且更均匀的辐射剂量。本研究旨在确定剂量递增的化疗联合IMRT用于局部晚期头颈部癌保留喉功能的安全性。
对T2 - 4、N1 - 3、M0的喉或下咽鳞状细胞癌患者采用同步推量IMRT进行治疗。测试了两个辐射剂量水平（DL）：在DL1中，原发肿瘤及受累淋巴结接受63 Gy/28次分割照射，选择性淋巴结接受51.8 Gy/28次分割照射。在DL2中，剂量分别为67.2 Gy/28次分割和56 Gy/28次分割，原发灶剂量递增9%。所有患者均接受2周期新辅助顺铂和5-氟尿嘧啶治疗以及同步顺铂治疗。收集急性毒性（NCICTC v.2.0）和晚期毒性（RTOG及改良的LENTSOM）情况。
入组30例患者，每个剂量水平15例。所有患者均完成治疗计划。在DL1中，急性3级毒性发生率分别为：疼痛27%、放射性皮炎20%、口干0%，67%的患者需要胃造瘘管。DL2中相应的发生率分别为40%、20%、7%和87%。DL2中3级吞咽困难和疼痛持续时间更长。关于黏膜炎，发现DL2愈合时间延长，第10周时2级黏膜炎发生率为58%。未观察到急性4级毒性。6个月时，DL2中有1例患者出现3级晚期毒性（吞咽困难）。未发现剂量限制性毒性。DL1的完全缓解率为80%，DL2为87%。
适度加速的化疗联合IMRT安全可行，依从性良好且急性毒性可接受。剂量递增是可行的，急性毒性无显著差异。需要更长时间的随访以确定晚期放射毒性发生率及肿瘤控制率。
