头颈部癌症的再放疗：在有效性和毒性之间的微妙平衡。
Reirradiation for head-and-neck cancer: delicate balance between effectiveness and toxicity.
机构信息
Maastricht University Medical Center, Department of Radiation Oncology (MAASTRO clinic), GROW School for Oncology and Developmental Biology, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands.
出版信息
Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):e111-8. doi: 10.1016/j.ijrobp.2011.01.004. Epub 2011 Feb 28.
PURPOSE
To analyze the effectiveness and toxicity of reirradiation (re-RT) for head-and-neck cancer.
METHODS AND MATERIALS
A retrospective data analysis was performed of 58 patients who underwent re-RT with curative intent. Re-RT was given as definitive treatment in 53% of patients, whereas salvage surgery preceded reirradiation in 47%. The median cumulative RT dose was 119 Gy (range, 76-140). Concurrent chemotherapy was administered with re-RT (CRT) in 57% of patients. Event-free survival was defined as survival without recurrence and without serious toxicity (≥Grade 3).
RESULTS
Median follow-up was 57 months (range, 9-140). Locoregional (LR) control was 50% at 2 and 5 years. The 2-year and 5-year overall survival (OS) was 42% and 34%. The following factors were associated with improved OS: postoperative re-RT (vs. primary re-RT), treatment with RT only (vs. CRT) and interval >3 years between previous RT and re-RT. For patients treated with postoperative re-RT and definitive re-RT, the 5-year OS was 49% and 20%, respectively. Patients treated with CRT had a 5-year OS of 13%. Serious (late) toxicity ≥Grade 3 was observed in 20 of 47 evaluable patients (43%). Three cases of treatment-related death were recorded. The 2- and 5-year serious toxicity-free interval was 59% and 55%, respectively. Associated with increased risk of serious toxicity were CRT and higher re-RT dose. The event-free survival rates at 2 and 5 years were 34% and 31%, respectively.
CONCLUSIONS
Re-RT in head-and-neck cancer is associated with poor survival rates of 13-20% in patients with inoperable disease treated with primary (chemo-) re-RT. For this subgroup, however, no other curative options are available. Long-term disease control and survival can be achieved in patients who receive re-RT as an adjunct to surgical resection. The rates of serious toxicity after re-RT are high, with an incidence of approximately 45% at 5 years. Approximately 1 in 3 patients survived re-RT without recurrence and severe complications.
目的
分析头颈部癌症再放疗（re-RT）的有效性和毒性。
方法和材料
对 58 例接受根治性再放疗的患者进行回顾性数据分析。再放疗作为确定性治疗在 53%的患者中进行，而在 47%的患者中，挽救性手术先于再放疗。中位累积放疗剂量为 119Gy（范围，76-140）。57%的患者接受再放疗同步化疗（CRT）。无复发生存定义为无复发且无严重毒性（≥3 级）的生存。
结果
中位随访时间为 57 个月（范围，9-140）。2 年和 5 年局部区域（LR）控制率分别为 50%。2 年和 5 年总生存率（OS）分别为 42%和 34%。以下因素与改善 OS 相关：术后再放疗（vs. 原发性再放疗）、仅放疗（vs. CRT）治疗和前次放疗与再放疗之间的间隔>3 年。对于接受术后再放疗和确定性再放疗的患者，5 年 OS 分别为 49%和 20%。接受 CRT 治疗的患者 5 年 OS 为 13%。在 47 例可评估患者中，有 20 例（43%）观察到严重（迟发性）毒性≥3 级。记录了 3 例与治疗相关的死亡。2 年和 5 年严重毒性无事件间隔分别为 59%和 55%。CRT 和更高的再放疗剂量与严重毒性风险增加相关。2 年和 5 年无事件生存率分别为 34%和 31%。
结论
对于无法手术的原发性（化疗）再放疗患者，头颈部癌症的再放疗与 13-20%的生存率相关。然而，对于这一分组，没有其他根治性选择。对于接受再放疗作为手术切除辅助治疗的患者，可以实现长期疾病控制和生存。再放疗后的严重毒性发生率较高，5 年时约为 45%。大约每 3 例患者中就有 1 例在接受再放疗后无复发和严重并发症。
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