Huang Kim, Xia Ping, Chuang Cynthia, Weinberg Vivian, Glastonbury Christine M, Eisele David W, Lee Nancy Y, Yom Sue S, Phillips Theodore L, Quivey Jeanne M
Department of Radiation Oncology, University of California San Francisco, San Francisco, California 94143-0226, USA.
Cancer. 2008 Aug 1;113(3):497-507. doi: 10.1002/cncr.23578.
Treatment outcomes for stage III and IV oropharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy without prior surgical resection were reviewed.
Between April 2000 and September 2004, 71 patients underwent IMRT concurrent with chemotherapy without prior surgical resection for stage III and IV oropharyngeal carcinoma. Chemotherapy was platinum based. The gross tumor volume (GTV) received 70 Gy in 2.12 Gy per fraction. The high-risk clinical tumor volume (CTV) received 59.4 Gy in 1.80 Gy per fraction, and the low-risk CTV received 54 Gy in 1.64 Gy per fraction.
With a median follow-up of 33 months, the 3-year local, regional, and locoregional progression-free probabilities were 94%, 94%, and 90%, respectively. The 3-year overall survival estimate was 83%. Locoregional failures occurred in the GTV in 7 patients. Acute grade 3 or 4 toxicity developed in 35 patients. A feeding gastrostomy was placed in 25 patients. Late xerostomia was grade 0 in 16 patients, grade 1 in 31 patients, and grade 2 in 24 patients at last follow-up. No patients experienced grade 3 or 4 late toxicity, except for 1 who developed osteoradionecrosis of the mandible.
Excellent local and regional control was achieved with IMRT and concurrent chemotherapy without prior surgical resection in the treatment of stage III and IV oropharyngeal carcinoma. Significant sparing of the parotid glands and other critical normal tissues was possible using IMRT with moderate acute toxicities and minimal severe late effects.
回顾性分析了采用调强放射治疗（IMRT）联合同步化疗且未行手术切除治疗的Ⅲ期和Ⅳ期口咽癌的治疗结果。
2000年4月至2004年9月期间，71例Ⅲ期和Ⅳ期口咽癌患者接受了IMRT联合同步化疗，且未行手术切除。化疗以铂类为基础。大体肿瘤体积（GTV）接受70 Gy照射，每次分割剂量为2.12 Gy。高危临床靶体积（CTV）接受59.4 Gy照射，每次分割剂量为1.80 Gy，低危CTV接受54 Gy照射，每次分割剂量为1.64 Gy。
中位随访33个月，3年局部、区域和区域局部无进展概率分别为94%、94%和90%。3年总生存估计值为83%。7例患者在GTV区域发生局部区域复发。35例患者出现3级或4级急性毒性反应。25例患者行胃造瘘术。末次随访时，16例患者口干分级为0级，31例为1级，24例为2级。除1例发生下颌骨放射性骨坏死外，无患者出现3级或4级晚期毒性反应。
在Ⅲ期和Ⅳ期口咽癌的治疗中，IMRT联合同步化疗且未行手术切除可实现良好的局部和区域控制。使用IMRT可显著保护腮腺和其他关键正常组织，急性毒性反应中等，严重晚期效应最小。
