Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California 95817, USA.
Int J Radiat Oncol Biol Phys. 2011 Aug 1;80(5):1423-9. doi: 10.1016/j.ijrobp.2010.04.011. Epub 2010 Jul 23.
To describe the spatial distribution of local-regional recurrence (LRR) among patients treated postoperatively with intensity-modulated radiotherapy (IMRT) for head and neck cancer.
The medical records of 90 consecutive patients treated by gross total resection and postoperative IMRT for squamous cell carcinoma of the head and neck from January 2003 to July 2009 were reviewed. Sites of disease were the oral cavity (43 patients), oropharynx (20 patients), larynx (15 patients), and hypopharynx (12 patients). Fifty patients (56%) received concurrent chemotherapy.
Seventeen of 90 patients treated with postoperative IMRT experienced LRR, yielding a 2-year estimate of local regional control of 80%. Among the LRR patients, 11 patients were classified as in-field recurrences, occurring within the physician-designated clinical target volume, and 6 patients were categorized as marginal recurrences. There were no out-of-field geographical misses. Sites of marginal LRRs included the contralateral neck adjacent to the spared parotid gland (3 patients), the dermal/subcutaneous surface (2 patients), and the retropharyngeal/retrostyloid lymph node region (1 patient).
Although the incidence of geographical misses was relatively low, the possibility of this phenomenon should be considered in the design of target volumes among patients treated by postoperative IMRT for head and neck cancer.
描述接受调强放疗（IMRT）治疗的头颈部癌症患者局部区域复发（LRR）的空间分布。
回顾了 2003 年 1 月至 2009 年 7 月期间，90 例接受根治性切除术后行 IMRT 治疗的鳞状细胞癌患者的病历。病变部位为口腔（43 例）、口咽（20 例）、喉（15 例）和下咽（12 例）。50 例患者（56%）接受了同期化疗。
90 例接受术后 IMRT 治疗的患者中有 17 例发生 LRR，2 年局部区域控制率估计为 80%。在 LRR 患者中，11 例为场内复发，发生在医生指定的临床靶区范围内，6 例为边缘复发。无场外地理遗漏。边缘 LRR 部位包括与保留腮腺相邻的对侧颈部（3 例）、真皮/皮下表面（2 例）和咽后/茎突后淋巴结区域（1 例）。
尽管地理遗漏的发生率相对较低，但在设计头颈部癌症患者术后 IMRT 的靶区时，应考虑到这种现象的可能性。
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