Agarwal Jai Prakash, Nemade Bhushan, Murthy Vedang, Ghosh-Laskar Sarbani, Budrukkar Ashwini, Gupta Tejpal, D'Cruz Anil, Pai Prathamesh, Chaturvedi Pankaj, Dinshaw Ketayun
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
Radiother Oncol. 2008 Oct;89(1):51-6. doi: 10.1016/j.radonc.2008.06.007. Epub 2008 Jul 21.
A significant proportion of advanced stage head and neck cancer patients are incurable and have a limited life expectancy. This study reports a single institution experience with a hypofractionated radiotherapy regimen for palliation of loco-regionally advanced and incurable HNSCC.
Between 2000 and 2005, 110 patients of unresectable HNSCC were treated with a palliative radiotherapy (40Gy in 16 fractions). Distressing symptoms were assessed before treatment. Patients with good objective regression with acceptable toxicity received further escalation of dose till 50Gy. We made three strata to compare symptomatic improvement namely percentage relief <50%, between 50-75% and >75% as compared to baseline.
Most common baseline distressing complaints were pain in 109 (99%) patients and dysphagia in 97 (88%) patients. Eleven patients (10%) had complete response (CR) and 80 (73%) patients had complete and partial response (PR). At completion of radiotherapy 26%, 57%, and 17% of patients had <50%, 50-75%, and >75% symptomatic relief, respectively. The overall PFS (defined as either complete disappearance of the disease or non-progression in the irradiated field) at 12 months was 55.1% (95% CI, 40.3%-69.9%). On multivariate analysis weight >50kg (p=0.049) and radiotherapy dose of more than 40Gy (p=0.012) were found to be significant for PFS. Acute and late reactions were acceptable.
The hypofractionated radiotherapy regimen evaluated is an effective treatment modality for sustained symptoms relief with good response rates and acceptable toxicity.
相当一部分晚期头颈癌患者无法治愈，预期寿命有限。本研究报告了一家机构采用大分割放疗方案姑息治疗局部区域晚期且无法治愈的头颈部鳞状细胞癌（HNSCC）的经验。
2000年至2005年期间，110例无法切除的HNSCC患者接受了姑息性放疗（16次分割，每次40Gy）。在治疗前评估困扰症状。客观缓解良好且毒性可接受的患者接受进一步剂量递增直至50Gy。我们划分了三个层次来比较症状改善情况，即与基线相比缓解百分比<50%、50 - 75%和>75%。
最常见的基线困扰症状是109例（99%）患者疼痛，97例（88%）患者吞咽困难。11例（10%）患者完全缓解（CR），80例（73%）患者完全缓解和部分缓解（PR）。放疗结束时，分别有26%、57%和17%的患者症状缓解<50%、50 - 75%和>75%。12个月时的总体无进展生存期（定义为疾病完全消失或照射野内无进展）为55.1%（95%CI，40.3% - 69.9%）。多因素分析发现体重>50kg（p = 0.049）和放疗剂量超过40Gy（p = 0.012）对无进展生存期有显著意义。急性和晚期反应均可接受。
所评估的大分割放疗方案是一种有效的治疗方式，可实现持续的症状缓解，缓解率良好且毒性可接受。
