St James's Institute of Oncology, Leeds, UK.
Radiat Oncol. 2011 May 24;6:54. doi: 10.1186/1748-717X-6-54.
To establish recurrence patterns among locally advanced head and neck non-nasopharyngeal squamous cell carcinoma (HNSCC) patients treated with radical (chemo-) radiotherapy and to correlate the sites of loco-regional recurrence with radiotherapy doses and target volumes
151 locally advanced HNSCC patients were treated between 2004-2005 using radical three-dimensional conformal radiotherapy. Patients with prior surgery to the primary tumour site were excluded. The sites of locoregional relapses were correlated with radiotherapy plans by the radiologist and a planning dosimetrist.
Median age was 59 years (range:34-89). 35 patients had stage III disease, 116 patients had stage IV A/B. 36 patients were treated with radiotherapy alone, 42 with induction chemotherapy, 63 with induction and concomitant chemoradiotherapy and 10 concomitant chemoradiotherapy. Median follow-up was 38 months (range 3-62). 3-year cause specific survival was 66.8%. 125 of 151 (82.8%) achieved a complete response to treatment. Amongst these 125 there were 20 local-regional recurrence, comprising 8 local, 5 regional and 7 simultaneous local and regional; synchronous distant metastases occurred in 7 of the 20. 9 patients developed distant metastases in the absence of locoregional failure. For the 14 local recurrences with planning data available, 12 were in-field, 1 was marginal, and 1 was out-of-field. Of the 11 regional failures with planning data available, 7 were in-field, 1 was marginal and 3 were out-of-field recurrences.
The majority of failures following non-surgical treatment for locally advanced HNSCC were loco-regional, within the radiotherapy target volume. Improving locoregional control remains a high priority.
本研究旨在分析局部晚期头颈部非鼻咽癌鳞状细胞癌（HNSCC）患者在接受根治性（放化疗）治疗后的复发模式，并将局部区域复发部位与放疗剂量和靶区体积相关联。
2004 年至 2005 年间，151 例局部晚期 HNSCC 患者接受了根治性三维适形放疗。排除了原发肿瘤部位曾接受过手术的患者。放射科医生和计划剂量师通过放疗计划将局部区域复发部位与患者进行关联。
中位年龄为 59 岁（范围：34-89 岁）。35 例患者为 III 期疾病，116 例患者为 IVA/B 期。36 例患者仅接受放疗，42 例患者接受诱导化疗，63 例患者接受诱导化疗和同期放化疗，10 例患者同期放化疗。中位随访时间为 38 个月（范围 3-62 个月）。3 年的疾病特异性生存率为 66.8%。151 例患者中，125 例（82.8%）对治疗有完全缓解。在这 125 例患者中，有 20 例发生局部区域复发，包括 8 例局部复发，5 例区域复发和 7 例同时局部和区域复发；20 例中有 7 例出现同步远处转移。7 例患者在无局部区域失败的情况下发生远处转移。在有计划数据的 14 例局部复发中，12 例为靶区内复发，1 例为边缘复发，1 例为靶区外复发。在有计划数据的 11 例区域失败中，7 例为靶区内复发，1 例为边缘复发，3 例为靶区外复发。
在接受非手术治疗的局部晚期 HNSCC 患者中，大多数失败是局部区域内的放疗靶区内。提高局部区域控制率仍是当务之急。
