Department of Radiation Oncology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
Int J Radiat Oncol Biol Phys. 2010 Aug 1;77(5):1391-6. doi: 10.1016/j.ijrobp.2009.07.005. Epub 2010 Jan 7.
Outcome in locoregionally advanced laryngeal carcinoma and hypopharyngeal carcinoma after conventional radiation techniques is known for modest disease control and considerable late toxicity. Considering the lack of standardization in prescription dose for intensity-modulated radiotherapy (IMRT), we aimed to compare the results after our methods of simultaneously integrated boost IMRT with published results.
Between March 2002 and December 2008, 65 hypopharyngeal, 31 supraglottic, and 27 locoregionally advanced glottic tumor patients underwent definitive IMRT (with simultaneous chemotherapy in 86%). Of these, 64% presented with locoregionally advanced disease. Mean follow-up was 26 months (range, 3-83 months), with a median of 21 months. Treatment (2.0-2.2 Gy per fraction, 66-72.6 Gy) followed a prospectively defined protocol. If the boost volume included more than half of the larynx or a substantial part of the pharynx, dose was limited to 2.0 Gy per fraction.
The 2-year local, nodal, and locoregional control (LRC) rates for the entire cohort were 82%, 90%, and 77%, respectively; the disease-free and overall survival rates were 75% and 83%, respectively. The ultimate 2-year LRC rate, including salvage surgery, was 86%. Laryngectomy was required in 2 LRC patients needing tracheostoma already before; 2 further LRC patients needed tracheostomy before IMRT and remained tracheostoma dependent, and 3 patients remained feeding tube dependent after IMRT. Salvage laryngectomy was successful in 8 of 11. Of all 123 patients, 91 patients (74%) are locoregionally controlled and live with a functional laryngopharynx.
Simultaneously integrated boost IMRT with limited acceptance of dose inhomogeneity resulted in very satisfactory disease control despite a slight left shift of planning target volume curves on the dose-volume histogram. Considering the treatment tolerance, a careful increase in dose in our patients seems possible. Dose-volume comparisons remain difficult because no international standards have been defined for contouring and volume-related dose distribution.
传统放射技术治疗局部晚期喉癌和下咽癌的疾病控制效果中等，晚期毒性较大。鉴于调强放疗（IMRT）处方剂量缺乏标准化，我们旨在比较同时整合升压 IMRT 方法与已发表结果的结果。
2002 年 3 月至 2008 年 12 月，65 例下咽癌、31 例声门上癌和 27 例局部晚期声门癌患者接受了根治性 IMRT（86%同时接受化疗）。其中 64%为局部晚期疾病。中位随访时间为 26 个月（范围 3-83 个月），中位随访时间为 21 个月。治疗（2.0-2.2Gy/分次，66-72.6Gy）遵循前瞻性定义的方案。如果升压体积包括一半以上的喉部或咽部的重要部分，则剂量限制为 2.0Gy/分次。
整个队列的 2 年局部、区域和局部区域控制（LRC）率分别为 82%、90%和 77%；无疾病和总生存率分别为 75%和 83%。包括挽救性手术在内的最终 2 年 LRC 率为 86%。2 例 LRC 患者在需要气管造口术之前已经需要进行喉切除术；2 例进一步的 LRC 患者在 IMRT 前需要气管造口术，并且仍然依赖于气管造口术，3 例患者在 IMRT 后仍然依赖于饲管。11 例中的 8 例挽救性喉切除术成功。在所有 123 例患者中，91 例（74%）局部控制良好，生活在功能完好的喉咽中。
同时整合升压 IMRT 接受剂量不均匀性的限制，尽管剂量-体积直方图上的计划靶区曲线略有左移，但仍能获得非常满意的疾病控制。考虑到治疗耐受性，在我们的患者中谨慎增加剂量似乎是可能的。由于尚未为轮廓和体积相关剂量分布定义国际标准，因此剂量-体积比较仍然困难。
