调强放疗同步加量推量照射和同期化疗治疗局部晚期头颈部鳞状细胞癌。
IMRT with simultaneous integrated boost and concurrent chemotherapy for locoregionally advanced squamous cell carcinoma of the head and neck.
机构信息
Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah 84112, USA.
出版信息
Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):e845-52. doi: 10.1016/j.ijrobp.2010.10.021. Epub 2010 Dec 16.
PURPOSE
To evaluate the efficacy and toxicity of accelerated radiotherapy with concurrent chemotherapy in advanced head-and-neck squamous cell carcinoma.
METHODS AND MATERIALS
Between April 2003 and May 2008, 43 consecutive patients with advanced head-and-neck squamous cell carcinoma received accelerated chemoradiation with concurrent cisplatin or cetuximab. The doses for intensity-modulated radiotherapy with simultaneous integrated boost were 67.5, 60.0, and 54 Gy in 30 daily fractions of 2.25, 2.0, and 1.8 Gy to the planning target volumes for gross disease, high-risk nodes, and low-risk nodes, respectively.
RESULTS
Of the patients, 90.7% completed chemoradiotherapy as prescribed. The median treatment duration was 43 days (range, 38-55 days). The complete response rate was 74.4%. With median follow-up of 36.7 months (range, 16.8-78.1 months) in living patients, the estimated 1-, 2-, and 5-year locoregional control, overall survival, and disease-free survival rates were 82%, 82%, and 82%; 73%, 65%, and 61%; and 73%, 73%, and 70%, respectively. One treatment-related death occurred from renal failure. Grade 3 mucositis and dermatitis occurred in 13 patients (30.2%) and 3 patients (6.9%), respectively. Grade 2 xerostomia occurred in 12 patients (27.9%). In patients with adequate follow-up, 82% were feeding tube free by 6 months after therapy; 13% remained feeding tube dependent at 1 year. Grade 3 soft-tissue fibrosis, esophageal stricture, osteoradionecrosis, and trismus occurred in 3 patients (6.9%), 5 patients (11.6%), 1 patient (2.3%), and 3 patients (6.9%), respectively.
CONCLUSIONS
Our results show that intensity-modulated radiotherapy with simultaneous integrated boost with concurrent chemotherapy improved local and regional control. Acute and late toxicities were tolerable and acceptable. A prospective trial of this fractionation regimen is necessary for further assessment of its efficacy and toxicity compared with other approaches.
目的
评估在晚期头颈部鳞状细胞癌中采用加速放疗并同步化疗的疗效和毒性。
方法和材料
在 2003 年 4 月至 2008 年 5 月期间，43 例晚期头颈部鳞状细胞癌患者接受了顺铂或西妥昔单抗同步化疗的加速放化疗。调强放疗同步推量的剂量为：大体肿瘤靶区 67.5Gy、高危淋巴结 60.0Gy、低危淋巴结 54Gy，分别在 30 天内完成，每天 3 次，每次分割剂量为 2.25Gy、2.0Gy 和 1.8Gy。
结果
90.7%的患者按规定完成了放化疗。中位治疗时间为 43 天（范围：38-55 天）。完全缓解率为 74.4%。在有存活患者的中位随访 36.7 个月（范围：16.8-78.1 个月）中，估计 1、2 和 5 年的局部区域控制率、总生存率和无疾病生存率分别为 82%、82%和 82%；73%、65%和 61%；73%、73%和 70%。1 例与治疗相关的死亡是肾衰竭所致。13 例（30.2%）患者出现 3 级黏膜炎和皮炎，3 例（6.9%）患者出现 3 级口干症。12 例（27.9%）患者出现 2 级口干症。在有足够随访的患者中，有 82%的患者在治疗后 6 个月时无需依赖进食管；13%的患者在 1 年时仍依赖进食管。3 例（6.9%）患者出现 3 级软组织纤维化、食管狭窄、放射性骨坏死和张口困难，5 例（11.6%）患者出现 2 级黏膜炎、皮炎，1 例（2.3%）患者出现 3 级口干症，3 例（6.9%）患者出现 2 级张口困难。
结论
我们的结果表明，调强放疗同步推量并同步化疗可改善局部和区域控制。急性和迟发性毒性是可耐受和可接受的。与其他方法相比，这种分割方案的前瞻性试验对于进一步评估其疗效和毒性是必要的。
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