Department of Radiation Medicine, Hofstra North Shore-Long Island Jewish School of Medicine, New Hyde Park, NY 11040, USA.
Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):986-93. doi: 10.1016/j.ijrobp.2011.08.017. Epub 2011 Dec 2.
To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma.
A total of 24 patients were enrolled in an institutional review board-approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy.
With a 31-month median follow-up (range, 13-45 months), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated.
This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond.
介绍一项前瞻性研究的初步毒性和生存结果，该研究旨在探讨适形调强放疗（ART）治疗口咽鳞癌。
这项经机构审查委员会批准的临床试验共纳入 24 例患者，对其中 22 例患者的数据进行了分析。每日 CT 引导下的摆位和形变图像配准，实现了临床靶区和避靶结构的连续勾画，以便进行 ART 计划。原发灶位于舌根 15 例，扁桃体 6 例，舌咽隐窝 1 例。20 例（91%）患者 AJCC 分期为 IV 期。T 分期分布为 T1 期 2 例，T2 期 12 例，T3 期 3 例，T4 期 5 例。N 分期分布为 N0 期 1 例，N1 期 2 例，N2a 期 5 例，N2b 期 12 例，N2c 期 2 例。其中 21 例（95%）患者接受了系统治疗。
中位随访时间为 31 个月（范围 13-45 个月），无原发灶失败，1 例淋巴结复发，2 年时局部和区域疾病控制率分别为 100%和 95%。基线肿瘤大小与绝对肿瘤体积治疗反应相关（p=0.018）。腮腺体积变化与置管时间相关（p=0.025）。急性毒性与常规调强放疗（IMRT）相似。记录了 1 年以上的慢性毒性和功能结果。
这是首次前瞻性评估局部晚期头颈部癌患者接受自动自适应再计划治疗后的发病率和生存结果。ART 仅需 1 次或 2 次治疗中再计划，即可提供剂量学优势。我们的初步临床结果显示，1 年随访及之后患者的功能恢复和疾病控制得到了保持。
