头颈部皮肤癌中神经周围浸润的放射治疗：迈向风险适应性治疗方法

Radiotherapy for perineural invasion in cutaneous head and neck carcinomas: toward a risk-adapted treatment approach.

作者信息

Jackson James E, Dickie Graeme J, Wiltshire Kirsty L, Keller Jacqui, Tripcony Lee, Poulsen Michael G, Hughes Mary, Allison Roger W, Martin Jarad M

机构信息

Cancer Care Services, Royal Brisbane and Woman's Hospital, Brisbane, Queensland, Australia.

出版信息

Head Neck. 2009 May;31(5):604-10. doi: 10.1002/hed.20991.

DOI:10.1002/hed.20991

PMID:19132719

Abstract

BACKGROUND

We retrospectively reviewed outcomes in patients treated with radiotherapy (RT) for cutaneous head and neck carcinoma with perineural invasion (PNI), with the aim of developing risk-adapted treatment guidelines.

METHODS

A total of 118 patients were treated with RT between April 1992 and July 2000. Ninety-seven patients had PNI discovered through histology (pPNI) and 21 patients had symptoms/signs of PNI (cPNI). All received RT (median dose, 55 Gy; range, 17-74): 114 postoperatively and 4 definitively. Median follow-up was 84 months (range, 4-201).

RESULTS

The 5-year local control (LC) rates were 90% with pPNI and 57% with cPNI (p < .0001). The pPNI and cPNI groups also differed in relapse-free survival (76% vs 46%, p = .003), disease-specific survival (90% vs 76%, p = .002), and overall survival (69% vs 57%, p = .03). pPNI patients with BCC histology (n = 42) had better LC (97% vs 84%, p = .02) than pPNI SCC (n = 55).

CONCLUSION

Surgery plus RT provides a high rate of LC in patients with pPNI, particularly those with BCC. Therapeutic improvements are needed for patients with cPNI.

摘要

背景

我们回顾性分析了接受放疗（RT）治疗的伴有神经周围侵犯（PNI）的头颈部皮肤癌患者的治疗结果，旨在制定风险适应性治疗指南。

方法

1992年4月至2000年7月期间，共有118例患者接受了放疗。97例患者通过组织学检查发现有PNI（pPNI），21例患者有PNI的症状/体征（cPNI）。所有患者均接受了放疗（中位剂量55 Gy；范围17 - 74 Gy）：114例为术后放疗，4例为根治性放疗。中位随访时间为84个月（范围4 - 201个月）。

结果

pPNI患者的5年局部控制（LC）率为90%，cPNI患者为57%（p <.0001）。pPNI组和cPNI组在无复发生存率（76%对46%，p =.003）、疾病特异性生存率（90%对76%，p =.002）和总生存率（69%对57%，p =.03）方面也存在差异。组织学类型为基底细胞癌（BCC）的pPNI患者（n = 42）的LC率（97%对84%，p =.02）优于鳞状细胞癌（SCC）的pPNI患者（n = 55）。