Studer Gabriela, Graetz Klaus W, Glanzmann Christoph
Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.
Radiat Oncol. 2008 Dec 17;3:43. doi: 10.1186/1748-717X-3-43.
Recurrent head neck cancer (rHNC) is a known unfavourable prognostic condition.The purpose of this work was to analyse our rHNC subgroup treated with salvage-intensity modulated radiation therapy (IMRT) for curable recurrence after initial surgery alone.
Between 4/2003-9/2008, 44 patients with squamous cell rHNC were referred for IMRT, mean/median 33/21 (3-144) months after initial surgery. None had prior head neck radiation. 41% underwent definitive, 59% postoperative IMRT (66-72.6 Gy). 70% had simultaneous chemotherapy.
Retrospective analysis of the outcome following salvage IMRT in rHNC patients was performed.
After mean/median 25/21 months (3-67), 22/44 (50%) patients were alive with no disease; 4 (9%) were alive with disease. 18 patients (41%) died of disease. Kaplan Meier 2-year disease specific survival (DSS), disease free survival (DFS), local and nodal control rates of the cohort were 59/49/56 and 68%, respectively.Known risk factors (advanced initial pTN, marginal initial resection, multiple recurrences) showed no significant outcome differences. Risk factors and the presence of macroscopic recurrence gross tumor volume (rGTV) in oral cavity patients vs others resulted in statistically significantly lower DSS (30 vs 70% at 2 years, p = 0.03). With respect to the assessed unfavourable outcome following salvage treatment, numbers needed to treat to avoid one recurrence with initial postoperative IMRT have, in addition, been calculated.
A low salvage rate of only approximately 50% at 2 years was found. Calculated numbers of patients needed to treat with postoperative radiation after initial surgery, in order to avoid recurrence and tumor-specific death, suggest a rather generous use of adjuvant irradiation, usually with simultaneous chemotherapy.
复发性头颈癌（rHNC）是一种已知的预后不良疾病。本研究的目的是分析我们对仅接受过初次手术的可治愈性复发的rHNC亚组患者采用挽救性调强放射治疗（IMRT）的情况。
在2003年4月至2008年9月期间，44例鳞状细胞rHNC患者被转诊接受IMRT治疗，初次手术后的平均/中位时间为33/21（3 - 144）个月。所有患者之前均未接受过头颈部放疗。41%的患者接受了根治性IMRT，59%接受了术后IMRT（66 - 72.6 Gy）。70%的患者同时接受了化疗。
对rHNC患者挽救性IMRT后的结局进行回顾性分析。
平均/中位随访25/21个月（3 - 67个月）后，22/44（50%）例患者无病存活；4例（9%）患者带瘤存活。18例患者（41%）死于疾病。该队列的Kaplan Meier 2年疾病特异性生存率（DSS）、无病生存率（DFS）、局部和区域控制率分别为59%、49%、56%和68%。已知的风险因素（初始pTN分期较晚、初次手术切缘阳性、多次复发）在结局方面无显著差异。口腔患者与其他患者的风险因素及宏观复发肿瘤总体积（rGTV）的存在导致DSS在统计学上显著降低（2年时分别为30%和70%，p = 0.03）。此外，针对挽救性治疗后评估的不良结局，还计算了初次术后IMRT避免一次复发所需治疗的患者数量。
发现2年时挽救率仅约为50%，较低。为避免复发和肿瘤特异性死亡，初次手术后接受放疗所需治疗的患者数量表明通常应较为广泛地使用辅助放疗，通常联合化疗。
