Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA 02115, USA.
Int J Radiat Oncol Biol Phys. 2011 Aug 1;80(5):1405-11. doi: 10.1016/j.ijrobp.2010.04.029. Epub 2010 Dec 20.
No single standard treatment paradigm is available for head-and-neck squamous cell carcinoma of an unknown primary (HNCUP). Bilateral neck radiotherapy with mucosal axis irradiation is widely used, with or without chemotherapy and/or surgical resection. Intensity-modulated radiotherapy (IMRT) is a highly conformal method for delivering radiation that is becoming the standard of care and might reduce the long-term treatment-related sequelae. We report the Dana-Farber Cancer Institute experience with IMRT-based treatment for HNCUP.
A retrospective study of all patients treated at the Dana-Farber Cancer Institute for HNCUP with IMRT between August 2004 and January 2009. The primary endpoint was overall survival; the secondary endpoints were locoregional and distant control, and acute and chronic toxicity.
A total of 24 patients with HNCUP were included. Of these patients, 22 had Stage N2 disease or greater. All patients underwent neck computed tomography, positron emission tomography-computed tomography, and examination under anesthesia with directed biopsies. Of the 24 patients, 22 received concurrent chemotherapy, and 7 (29%) also underwent induction chemotherapy. The median involved nodal dose was 70 Gy, and the median mucosal dose was 60 Gy. With a median follow-up of 2.1 years, the 2-year actuarial overall survival and locoregional control rate was 92% and 100%, respectively. Only 25% of the patients had Grade 2 xerostomia, although 11 patients (46%) required esophageal dilation for stricture.
In a single-institution series, IMRT-based chemoradiotherapy for HNCUP was associated with superb overall survival and locoregional control. The xerostomia rates were promising, but the aggressive therapy was associated with significant rates of esophageal stenosis.
对于不明原发灶的头颈部鳞癌（HNCUP），目前尚无单一的标准治疗模式。广泛采用双侧颈部放疗联合黏膜轴照射，可联合化疗和/或手术切除。调强放疗（IMRT）是一种高度适形的放疗方法，正在成为治疗标准，并且可能减少长期治疗相关的后遗症。我们报告了达纳-法伯癌症研究所（Dana-Farber Cancer Institute）使用基于 IMRT 的治疗方案治疗 HNCUP 的经验。
对 2004 年 8 月至 2009 年 1 月期间在达纳-法伯癌症研究所（Dana-Farber Cancer Institute）接受 IMRT 治疗的 HNCUP 患者进行回顾性研究。主要终点是总生存；次要终点是局部区域和远处控制，以及急性和慢性毒性。
共纳入 24 例 HNCUP 患者。其中 22 例患者有 N2 期或更高级别的疾病。所有患者均行颈部 CT、正电子发射断层扫描-CT 以及麻醉下检查并进行导向活检。24 例患者中，22 例接受同期化疗，7 例（29%）还接受诱导化疗。受累淋巴结的中位剂量为 70Gy，黏膜的中位剂量为 60Gy。中位随访 2.1 年后，2 年的总生存率和局部区域控制率分别为 92%和 100%。仅有 25%的患者出现 2 级口干症，尽管 11 例（46%）患者因狭窄需要食管扩张。
在单机构系列中，基于 IMRT 的放化疗治疗 HNCUP 具有良好的总生存率和局部区域控制率。口干症的发生率很有希望，但这种强化治疗与严重的食管狭窄发生率相关。
