St. James's Institute of Oncology, St. James's University Hospital, Leeds Teaching Hospitals, Leeds, UK.
Clin Oncol (R Coll Radiol). 2011 Mar;23(2):141-8. doi: 10.1016/j.clon.2010.09.006. Epub 2010 Oct 8.
A significant proportion of patients with head and neck squamous cell carcinoma are unsuitable for radical treatment due to factors including tumour stage, performance status and co-morbidity. Palliative radiotherapy has a useful role in the control of local symptoms. This study documented the outcome with split-course hypofractionated radiotherapy.
Thirty-three previously untreated patients with head and neck squamous cell carcinoma were treated with palliative intent with split-course radiotherapy, with an initial 20 Gy in five fractions over 1 week, a 2 week gap, and then a further 20 Gy in five fractions over 1 week at the Yorkshire Cancer Centre between January 2004 and December 2007. Data were collected retrospectively from case notes and radiotherapy records.
Thirty (91%) patients had stage IV A-B disease. World Health Organization performance status was 2 or 3 in 19 (58%) patients. The median age was 76 years (range 48-91 years). Twenty-five (76%) patients were men. Symptomatic improvement was reported in 26 (79%) patients at 4-6 weeks of follow-up. Thirteen (39%) patients had a complete tumour response and 11 (33%) patients had a partial response as assessed clinically, and in some cases radiologically. The median overall survival was 9 months (range 3-43 months). Progression-free survival at 1 and 2 years was 35 and 25%, respectively. Overall survival at 1 and 2 years was 42 and 34%, respectively. Treatment was generally well tolerated; admission for nasogastric feeding and/or supportive care was required in only six patients. Radiation Therapy Oncology Group grade 3 toxicity was documented for skin in one patient, for mucosa in two patients and for oesophagitis in three patients.
Split-course hypofractionated radiotherapy is an effective palliative regimen with acceptable toxicity.
由于肿瘤分期、身体状况和合并症等因素，相当一部分头颈部鳞状细胞癌患者不适合根治性治疗。姑息性放疗在控制局部症状方面具有重要作用。本研究记录了分段低分割放疗的结果。
2004 年 1 月至 2007 年 12 月，在约克郡癌症中心，采用分段低分割放疗对 33 例未经治疗的头颈部鳞状细胞癌患者进行姑息性治疗，初始剂量为 20 Gy，分 5 次，每周 1 次，共 5 次；2 周后剂量为 20 Gy，分 5 次，每周 1 次。数据从病历和放疗记录中回顾性收集。
30 例（91%）患者为 IVA-B 期疾病。19 例（58%）患者的世界卫生组织体能状况为 2 或 3 级。中位年龄为 76 岁（48-91 岁）。25 例（76%）患者为男性。26 例（79%）患者在随访 4-6 周时报告症状改善。13 例（39%）患者的肿瘤完全缓解，11 例（33%）患者的肿瘤部分缓解，在某些情况下通过影像学评估。中位总生存期为 9 个月（3-43 个月）。1 年和 2 年无进展生存率分别为 35%和 25%。1 年和 2 年总生存率分别为 42%和 34%。治疗总体上耐受性良好；仅 6 例患者需要鼻饲和/或支持性治疗入院。1 例患者发生皮肤 3 级放射治疗肿瘤学组毒性，2 例患者发生黏膜 3 级毒性，3 例患者发生食管炎 3 级毒性。
分段低分割放疗是一种有效的姑息治疗方案，具有可接受的毒性。
