Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, and University of Toronto, Toronto, ON, Canada.
Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):958-63. doi: 10.1016/j.ijrobp.2010.06.055. Epub 2010 Oct 14.
To examine the patterns of care, outcomes, and prognostic factors for patients with head-and-neck cancer (HNC) treated with palliative radiotherapy (RT).
An institutional HNC anthology and electronic patient records were used to identify patients with previously untreated HNC of mucosal or salivary gland origin who underwent palliative RT at our institution between July 2003 and June 2008. Overall survival was determined from the start date of RT to either the date of death or the date of last follow-up for living patients. The data were censored if the subject was either lost to follow-up or had not been seen for follow-up at our institution for ≥4 months.
We identified 148 eligible patients. The median age was 72 years (range, 19-94). Of the 148 patients, 12 had Stage II-III, 39 Stage IVA, 36 Stage IVB, and 54 Stage IVC; for 7 patients, the stage was unknown. Oropharyngeal primary cancer (40) was the most common primary site. The Eastern Cooperative Oncology Group performance status was 0 in 15, 1 in 69, 2 in 40, 3 in 19, and 4 in 5 patients. The Adult Co-morbidity Evaluation-27 scale was 0 in 33, 1 in 47, 2 in 44, and 3 in 21. The median radiation dose was 50 Gy (range, 2-70), the median fraction number was 20 (range, 1-40), and the median total treatment time (including breaks) was 29 days (range, 1-80). At analysis, 108 patients (73%) had died, 20 (13.5%) were alive, and 20 (13.5%) had been censored. The median follow-up was 4.8 months, and the median survival time was 5.2 months. Information on the treatment response was available for 103 patients (70%). On multivariate analysis, the radiation dose was an independent predictor of both overall survival (hazard ratio 0.97, 95% confidence interval 0.96-0.99, p <.01) and treatment response (odds ratio 1.05, 95% confidence interval 1.01-1.08, p <.01).
For patients considered unsuitable for curative RT, the radiation dose might be an independent predictive factor for both overall survival and treatment response. Additional research is required to more effectively select those patients who might benefit from more aggressive treatment.
研究接受姑息性放疗（RT）的头颈部癌症（HNC）患者的治疗模式、结局和预后因素。
本研究使用机构性 HNC 文集和电子患者记录，确定了 2003 年 7 月至 2008 年 6 月期间在我院接受姑息性 RT 的初治黏膜或涎腺来源 HNC 且无远处转移的患者。总生存时间从 RT 开始日期计算至死亡日期或最后一次随访日期（对于存活患者）。如果患者失访或在我院未接受≥4 个月的随访，则对数据进行删失。
共纳入 148 例符合条件的患者。中位年龄为 72 岁（范围，19-94 岁）。148 例患者中，12 例为 II-III 期，39 例为 IVA 期，36 例为 IVB 期，54 例为 IVC 期；7 例患者分期不详。口咽原发癌（40 例）是最常见的原发部位。Eastern Cooperative Oncology Group 表现状态为 0 的患者 15 例，1 分的 69 例，2 分的 40 例，3 分的 19 例，4 分的 5 例。成人合并症评估-27 量表评分 0 分的患者 33 例，1 分的 47 例，2 分的 44 例，3 分的 21 例。中位放疗剂量为 50 Gy（范围，2-70），中位分割次数为 20（范围，1-40），中位总治疗时间（包括休息）为 29 天（范围，1-80）。分析时，108 例（73%）患者死亡，20 例（13.5%）存活，20 例（13.5%）被删失。中位随访时间为 4.8 个月，中位生存时间为 5.2 个月。103 例（70%）患者的治疗反应信息可用。多因素分析显示，放疗剂量是总生存（风险比 0.97，95%置信区间 0.96-0.99，p<.01）和治疗反应（比值比 1.05，95%置信区间 1.01-1.08，p<.01）的独立预测因素。
对于不适合根治性 RT 的患者，放疗剂量可能是总生存和治疗反应的独立预测因素。需要进一步研究以更有效地选择那些可能从更积极治疗中获益的患者。
