Kiprian Dorota, Jarząbski Andrzej, Pawłowska Beata, Michalski Wojciech, Kawecki Andrzej
Klinika Nowotworów Głowy i Szyi Centrum Onkologii Instytut im Marii Skłodowskiej-Curie w Warszawie.
Otolaryngol Pol. 2011 Sep;65(5 Suppl):117-25. doi: 10.1016/S0030-6657(11)70719-3.
Concomitant radiochemotherapy become the treatment of choice for locally advanced SCHNC. This strategy of treatment has a limitation, which is an acute and late toxicity. The IMRT technique provides the possibility of better sparing of healthy tissue. Radiobiological and clinical data also suggest that accelerated fractionation and higher dose per fraction given in GTV may produce better locoregional control. Therefore it might be expected that concomitant chemotherapy and SIB-IMRT radiotherapy could increase locoregional control and reduce acute and late radiation reactions. The evaluation of early results and toxicity of this treatment modality is presented.
The evaluation of the early results and toxicity of SIB-IMRT radiotherapy given concomitantly with cisplatin for locally advanced squamous cell head and neck cancer (SCHNC).
SIB-IMRT technique was applied. The boost volume was limited to the GTV + 3mm margin (macroscopic tumor extension was defined on the basis of CT and/or MRI examinations). Dose per fraction given to this volume was 2.25 Gy up to 67.5 Gy of total dose. The PTV-CTV + 3mm - was defined as an area of increased risk of microscopic spread. Dose per fraction given to this volume was 2 Gy up to 60 Gy. The PTV1-ETV+ 3mm (electively irradiated volume) received dose per fraction -1.8 Gy up to 54-56 Gy. Overall treatment time was 6 weeks (5 fractions per week, 30 fractions). Concomitant chemotherapy consisted of cisplatin in daily dose100mg/m2 given two times during irradiation (1 and 22 day of treatment). The evaluation of early tolerance was performed once weekly during the treatment than during the follow up every 2 months. The early reactions were scored according to the EORTC/RTOG scale.
Between June 2006 and December 2009 99 patients diagnosed with III and IV clinical stage of SCHNC were treated with this method. 65 patients were diagnosed with oropharyngeal cancer, 18 with laryngeal cancer and 16 with hypopharyngeal cancer. PEG was performed at 65 patients before treatment for better alimentation during radiochemotherapy.
No severe life risking complications were observed a no concequentional late effects were observed. Extended mucositis grade III according RTOG/EORTC scale were observed only in boost region in 80% patients just after treatment was completed. In 2 patients ulceration were observed in tumour side which have healed up spontaneously within two months after treatment. 55% patients were suffering for III xerostomia and 41% for middle after the treatment. Majority of side effects were cured within 4 months after irradiation. The PEG was removing in 92% patients 2 months after treatment. The median follow-up time is 28 months (ranged from 14 m to 58 m). Actuarial 2-years overall survival and disease-free survival is respectively 90% and 82%, probability of locoregional recurrence at 2-years is 14% and 5-years estimated is 17,5%.
At the present moment it might be concluded that accelerated radiotherapy with SIB-IMRT given concomitantly with cisplatin produce excellent local control in patients treated of III-IV stage SCHNC without increasing toxicity.
同步放化疗已成为局部晚期头颈部鳞状细胞癌（SCHNC）的首选治疗方法。这种治疗策略存在局限性，即有急性和晚期毒性。调强放疗（IMRT）技术为更好地保护健康组织提供了可能。放射生物学和临床数据还表明，加速分割以及在大体肿瘤体积（GTV）给予更高的分次剂量可能产生更好的局部区域控制。因此，可以预期同步化疗和同步整合加量调强放疗（SIB-IMRT）可提高局部区域控制并减少急性和晚期放射反应。本文介绍了这种治疗方式的早期结果及毒性评估。
评估同步顺铂化疗的SIB-IMRT放疗对局部晚期头颈部鳞状细胞癌（SCHNC）的早期结果及毒性。
应用SIB-IMRT技术。推量体积限于GTV + 3mm边界（根据CT和/或MRI检查确定宏观肿瘤范围）。给予该体积的分次剂量为2.25 Gy，总剂量达67.5 Gy。计划靶体积（PTV）-临床靶体积（CTV）+ 3mm - 被定义为微小播散风险增加区域。给予该体积的分次剂量为2 Gy，总剂量达60 Gy。PTV1-选择性照射体积（ETV）+ 3mm接受的分次剂量为1.8 Gy，总剂量达54 - 56 Gy。总治疗时间为6周（每周5次，共30次）。同步化疗包括在放疗期间（治疗第1天和第22天）给予顺铂，每日剂量100mg/m²，共2次。治疗期间每周评估一次早期耐受性，随访期间每2个月评估一次。根据欧洲癌症研究与治疗组织（EORTC）/美国放射肿瘤学会（RTOG）标准对早期反应进行评分。
2006年6月至2009年12月期间，99例诊断为临床III期和IV期SCHNC的患者采用该方法治疗。65例患者诊断为口咽癌，18例为喉癌，16例为下咽癌。65例患者在治疗前进行了经皮内镜下胃造口术（PEG），以便在放化疗期间更好地营养支持。
未观察到严重的危及生命的并发症，也未观察到明显的晚期效应。根据RTOG/EORTC标准，仅在治疗完成后，80%的患者在推量区域观察到III级扩展性黏膜炎。2例患者在肿瘤侧出现溃疡，治疗后2个月内自行愈合。55%的患者治疗后出现III级口干，41%的患者出现中度口干。大多数副作用在放疗后4个月内治愈。92%的患者在治疗后2个月拔除了PEG。中位随访时间为28个月（范围为14个月至58个月）。2年总生存率和无病生存率分别为90%和82%，2年局部区域复发概率为14%，5年估计为17.5%。
目前可以得出结论，同步顺铂化疗的SIB-IMRT加速放疗在治疗III-IV期SCHNC患者时可产生出色的局部控制，且不增加毒性。
