Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA 94305, USA.
Int J Radiat Oncol Biol Phys. 2011 Aug 1;80(5):1412-22. doi: 10.1016/j.ijrobp.2010.04.031. Epub 2010 Aug 2.
Few studies have evaluated the use of intensity-modulated radiotherapy (IMRT) for squamous cell carcinoma (SCC) of the oral cavity (OC). We report clinical outcomes and failure patterns for these patients.
Between October 2002 and June 2009, 37 patients with newly diagnosed SCC of the OC underwent postoperative (30) or definitive (7) IMRT. Twenty-five patients (66%) received systemic therapy. The median follow-up was 38 months (range, 10-87 months). The median interval from surgery to RT was 5.9 weeks (range, 2.1-10.7 weeks).
Thirteen patients experienced local-regional failure at a median of 8.1 months (range, 2.4-31.9 months), and 2 additional patients experienced local recurrence between surgery and RT. Seven local failures occurred in-field (one with simultaneous nodal and distant disease) and two at the margin. Four regional failures occurred, two in-field and two out-of-field, one with synchronous metastases. Six patients experienced distant failure. The 3-year actuarial estimates of local control, local-regional control, freedom from distant metastasis, and overall survival were 67%, 53%, 81%, and 60% among postoperative patients, respectively, and 60%, 60%, 71%, and 57% among definitive patients. Four patients developed Grade ≥ 2 chronic toxicity. Increased surgery to RT interval predicted for decreased LRC (p = 0.04).
Local-regional control for SCC of the OC treated with IMRT with or without surgery remains unsatisfactory. Definitive and postoperative IMRT have favorable toxicity profiles. A surgery-to-RT interval of < 6 weeks improves local-regional control. The predominant failure pattern was local, suggesting that both improvements in target delineation and radiosensitization and/or dose escalation are needed.
鲜有研究评估调强放疗（IMRT）在口腔鳞状细胞癌（SCC）中的应用。我们报告这些患者的临床结果和失败模式。
2002 年 10 月至 2009 年 6 月，37 例新诊断的口腔 SCC 患者接受了术后（30 例）或根治性（7 例）IMRT。25 例（66%）患者接受了系统治疗。中位随访时间为 38 个月（范围 10-87 个月）。从手术到 RT 的中位间隔为 5.9 周（范围 2.1-10.7 周）。
13 例患者在中位时间 8.1 个月（范围 2.4-31.9 个月）时出现局部区域失败，另外 2 例患者在手术和 RT 之间出现局部复发。7 例局部失败发生在靶区内（1 例同时发生淋巴结和远处疾病），2 例发生在靶区边缘。4 例发生区域失败，2 例在靶区内，2 例在靶区外，1 例同时发生远处转移。6 例患者发生远处转移失败。术后患者的 3 年局部控制、局部区域控制、无远处转移生存率和总生存率的估计分别为 67%、53%、81%和 60%，根治性患者分别为 60%、60%、71%和 57%。4 例患者发生≥2 级慢性毒性。手术至 RT 间隔增加预测局部区域控制降低（p=0.04）。
接受手术或不接受手术的 IMRT 治疗口腔 SCC 的局部区域控制仍不理想。根治性和术后 IMRT 的毒性谱良好。手术至 RT 间隔<6 周可改善局部区域控制。主要失败模式为局部，表明需要改进靶区勾画、放射增敏和/或剂量升级。
