Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):291-8. doi: 10.1016/j.ijrobp.2010.10.041. Epub 2010 Dec 16.
To update the Memorial Sloan-Kettering Cancer Center's experience with intensity-modulated radiotherapy (IMRT) in the treatment of oropharyngeal cancer (OPC).
Between September 1998 and April 2009, 442 patients with histologically confirmed OPC underwent IMRT at our center. There were 379 men and 63 women with a median age of 57 years (range, 27-91). The disease was Stage I in 2%, Stage II in 4%, Stage III in 21%, and Stage IV in 73% of patients. The primary tumor subsite was tonsil in 50%, base of tongue in 46%, pharyngeal wall in 3%, and soft palate in 2%. The median prescription dose to the planning target volume of the gross tumor was 70 Gy for definitive (n = 412) cases and 66 Gy for postoperative cases (n = 30). A total 404 patients (91%) received chemotherapy, including 389 (88%) who received concurrent chemotherapy, the majority of which was platinum-based.
Median follow-up among surviving patients was 36.8 months (range, 3-135). The 3-year cumulative incidence of local failure, regional failure, and distant metastasis was 5.4%, 5.6%, and 12.5%, respectively. The 3-year OS rate was 84.9%. The incidence of late dysphagia and late xerostomia ≥Grade 2 was 11% and 29%, respectively.
Our results confirm the feasibility of IMRT in achieving excellent locoregional control and low rates of xerostomia. According to our knowledge, this study is the largest report of patients treated with IMRT for OPC.
更新纪念斯隆-凯特琳癌症中心（Memorial Sloan-Kettering Cancer Center）在调强放疗（intensity-modulated radiotherapy，IMRT）治疗口咽癌（oropharyngeal cancer，OPC）方面的经验。
1998 年 9 月至 2009 年 4 月期间，我们中心有 442 例组织学确诊的 OPC 患者接受了 IMRT。其中 379 例为男性，63 例为女性，中位年龄为 57 岁（范围，27-91 岁）。疾病分期为 I 期 2%，II 期 4%，III 期 21%，IV 期 73%。原发肿瘤部位为扁桃体 50%，舌根 46%，咽壁 3%，软腭 2%。大体肿瘤计划靶区的中位处方剂量为根治性治疗（n=412）70Gy，术后治疗（n=30）66Gy。404 例（91%）患者接受了化疗，包括 389 例（88%）接受了同期化疗，其中大多数为铂类为基础的化疗。
生存患者的中位随访时间为 36.8 个月（范围，3-135 个月）。3 年局部失败、区域失败和远处转移的累积发生率分别为 5.4%、5.6%和 12.5%。3 年总生存率为 84.9%。晚期吞咽困难和晚期口干≥2 级的发生率分别为 11%和 29%。
我们的结果证实了 IMRT 实现优异的局部控制和低口干发生率的可行性。据我们所知，这是最大的一组接受 IMRT 治疗 OPC 的患者报告。
