Department of Radiation Oncology, University of California, Davis Cancer Center, Sacramento, CA 95817, USA.
Int J Radiat Oncol Biol Phys. 2011 Jul 1;80(3):669-76. doi: 10.1016/j.ijrobp.2010.02.023. Epub 2010 Jun 12.
To report a single-institutional experience using intensity-modulated radiotherapy with daily image-guided radiotherapy for the reirradiation of recurrent and second cancers of the head and neck.
Twenty-one consecutive patients were prospectively treated with intensity-modulated radiotherapy from February 2006 to March 2009 to a median dose of 66 Gy (range, 60-70 Gy). None of these patients received concurrent chemotherapy. Daily helical megavoltage CT scans were obtained before each fraction as part of an image-guided radiotherapy registration protocol for patient alignment.
The 1- and 2-year estimates of in-field control were 72% and 65%, respectively. A total of 651 daily megavoltage CT scans were obtained. The mean systematic shift to account for interfraction motion was 1.38 ± 1.25 mm, 1.79 ± 1.45 mm, and 1.98 ± 1.75 mm for the medial-lateral, superior-inferior, and anterior-posterior directions, respectively. Pretreatment shifts of >3 mm occurred in 19% of setups in the medial-lateral, 27% in the superior-inferior, and 33% in the anterior-posterior directions, respectively. There were no treatment-related fatalities or hospitalizations. Complications included skin desquamation, odynophagia, otitis externa, keratitis, naso-lacrimal duct stenosis, and brachial plexopathy.
Intensity-modulated radiotherapy with daily image guidance results in effective disease control with relatively low morbidity and should be considered for selected patients with recurrent and second primary cancers of the head and neck.
报告一家机构使用调强放疗（IMRT）联合每日图像引导放疗（IGRT）对头颈部复发性和第二原发癌进行再放疗的经验。
21 例连续患者于 2006 年 2 月至 2009 年 3 月期间接受调强放疗，中位剂量为 66 Gy（范围为 60-70 Gy）。这些患者均未接受同期化疗。作为患者配准的图像引导放疗注册方案的一部分，在每次分割治疗前均获得每日螺旋兆伏 CT 扫描。
1 年和 2 年的局部控制率估计分别为 72%和 65%。共获得 651 次每日兆伏 CT 扫描。为了纠正分次间运动，系统误差的平均校正值分别为 1.38±1.25mm、1.79±1.45mm 和 1.98±1.75mm，用于左右、上下和前后方向。在左右方向，19%的摆位中存在>3mm的预治疗偏移，上下方向为 27%，前后方向为 33%。无治疗相关的死亡或住院。并发症包括皮肤脱皮、吞咽困难、外耳道炎、角膜炎、鼻泪管狭窄和臂丛神经病。
调强放疗联合每日图像引导可有效控制疾病，发病率相对较低，应考虑用于选择的头颈部复发性和第二原发癌患者。
