头颈部鳞状细胞癌调强放疗后远处转移。
Distant metastases in head-and-neck squamous cell carcinoma treated with intensity-modulated radiotherapy.
机构信息
Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
出版信息
Int J Radiat Oncol Biol Phys. 2012 Jun 1;83(2):684-9. doi: 10.1016/j.ijrobp.2011.07.014. Epub 2011 Dec 12.
PURPOSE
To determine the pattern and risk factors for distant metastases in head-and-neck squamous cell carcinoma (HNSCC) after curative treatment with intensity-modulated radiotherapy (IMRT).
METHODS AND MATERIALS
This was a retrospective study of 284 HNSCC patients treated in a single institution with IMRT. Sites included were oropharynx (125), oral cavity (70), larynx (55), hypopharynx (17), and unknown primary (17). American Joint Committee on Cancer stage distribution includes I (3), II (19), III (42), and IV (203). There were 224 males and 60 females with a median age of 57. One hundred eighty-six patients were treated with definitive IMRT and 98 postoperative IMRT. One hundred forty-nine patients also received concurrent cisplatin-based chemotherapy.
RESULTS
The median follow-up for all patients was 22.8 months (range, 0.07-77.3 months) and 29.5 months (4.23-77.3 months) for living patients. The 3-year local recurrence-free survival, regional recurrence-free survival, locoregional recurrence-free survival, distant metastasis-free survival, and overall survival were 94.6%, 96.4%, 92.5%, 84.1%, and 68.95%, respectively. There were 45 patients with distant metastasis. In multivariate analysis, distant metastasis was strongly associated with N stage (p = 0.046), T stage (p < 0.0001), and pretreatment maximum standardized uptake value of the lymph node (p = 0.006), but not associated with age, gender, disease sites, pretreatment standardized uptake value of the primary tumor, or locoregional control. The freedom from distant metastasis at 3 years was 98.1% for no factors, 88.6% for one factor, 68.3% for two factors, and 41.7% for three factors (p < 0.0001 by log-rank test).
CONCLUSION
With advanced radiation techniques and concurrent chemotherapy, the failure pattern has changed with more patients failing distantly. The majority of patients with distant metastases had no local or regional failures, indicating that these patients might have microscopic distant disease before treatment. The clinical factors identified here should be incorporated in future clinical trials.
目的
确定调强放疗（IMRT）根治性治疗后头颈部鳞状细胞癌（HNSCC）远处转移的模式和危险因素。
方法和材料
这是一项对 284 例在单机构接受 IMRT 治疗的 HNSCC 患者进行的回顾性研究。包括口咽（125 例）、口腔（70 例）、喉（55 例）、下咽（17 例）和不明原发灶（17 例）。美国癌症联合委员会（AJCC）分期分布为 I 期（3 例）、II 期（19 例）、III 期（42 例）和 IV 期（203 例）。224 例为男性，60 例为女性，中位年龄为 57 岁。186 例患者接受了根治性 IMRT，98 例接受了术后 IMRT。149 例患者还接受了顺铂为基础的同期化疗。
结果
所有患者的中位随访时间为 22.8 个月（0.07-77.3 个月），生存患者的中位随访时间为 29.5 个月（4.23-77.3 个月）。3 年局部无复发生存率、区域无复发生存率、局部区域无复发生存率、无远处转移生存率和总生存率分别为 94.6%、96.4%、92.5%、84.1%和 68.95%。有 45 例患者发生远处转移。多因素分析显示，远处转移与 N 分期（p = 0.046）、T 分期（p < 0.0001）和淋巴结预处理最大标准化摄取值（p = 0.006）密切相关，但与年龄、性别、疾病部位、原发肿瘤预处理标准化摄取值或局部区域控制无关。无危险因素的患者 3 年无远处转移率为 98.1%，有 1 个危险因素的患者为 88.6%，有 2 个危险因素的患者为 68.3%，有 3 个危险因素的患者为 41.7%（log-rank 检验，p < 0.0001）。
结论
随着先进的放疗技术和同期化疗的应用，失败模式发生了变化，越来越多的患者出现远处转移。大多数发生远处转移的患者没有局部或区域失败，表明这些患者在治疗前可能已经存在微小的远处疾病。这里确定的临床因素应纳入未来的临床试验中。
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