Pramana Ariyanto, Browne Lois, Graham Peter H
St George Cancer Care Centre, Kogarah, Australia.
J Med Imaging Radiat Oncol. 2012 Feb;56(1):100-8. doi: 10.1111/j.1754-9485.2011.02326.x.
Information regarding the addition of tissue equivalent bolus to adjuvant radiotherapy (RT) for intra-parotid metastatic head and neck cutaneous squamous cell carcinoma is lacking. This study aimed to evaluate the effect of bolus versus no bolus on the patterns of regional and distant recurrence, regional control (RC), cancer-specific survival (CSS), overall survival, RT toxicity and RT interruption.
A retrospective study was performed on consecutive patients diagnosed between 1994 and 2008 with metastatic head and neck cutaneous squamous cell carcinoma who were treated with parotidectomy ± selective neck dissection and adjuvant RT ± parotid bolus.
Seventy-five patients were identified: 64 males and 11 females, with median age of 79 years (range 40-96) of which 39 had bolus during RT. Median follow up was 48 months (range 4-177). There were 23 regional recurrences - 14 dermal, six dermal + nodal and three isolated nodal - and only two systemic recurrences. Nine patients had RT interruption >6 days due to acute skin toxicity. Bolus was associated with increased grade ≥3 radiation dermatitis (P = 0.02). RT interruption >6 days was significantly associated with inferior RC and hazard ratio, 2.83 (95% confidence interval: 1.04-7.71, P = 0.042). Lympho-vascular space invasion, positive margins and nodes >2 cm were adversely significant on CSS multivariate analysis. RC, CSS and overall survival at 5 years were 67, 66 and 52%, respectively.
Dermal involvement dominated the pattern of regional recurrence. Bolus was associated with significantly worse skin reaction. Bolus use was not associated with a significant overall benefit on RC. This analysis does not support the use of bolus as applied in this cohort.
关于在腮腺内转移性头颈部皮肤鳞状细胞癌的辅助放疗（RT）中添加组织等效填充物的相关信息尚缺乏。本研究旨在评估使用填充物与不使用填充物对区域和远处复发模式、区域控制（RC）、癌症特异性生存（CSS）、总生存、放疗毒性和放疗中断的影响。
对1994年至2008年间诊断为转移性头颈部皮肤鳞状细胞癌并接受腮腺切除术±选择性颈部清扫术及辅助放疗±腮腺填充物治疗的连续患者进行回顾性研究。
共纳入75例患者，其中男性64例，女性11例，中位年龄79岁（范围40 - 96岁），其中39例在放疗期间使用了填充物。中位随访时间为48个月（范围4 - 177个月）。有23例区域复发，其中14例为皮肤复发，6例为皮肤+淋巴结复发，3例为孤立性淋巴结复发，仅有2例全身复发。9例患者因急性皮肤毒性导致放疗中断>6天。使用填充物与≥3级放射性皮炎增加相关（P = 0.02）。放疗中断>6天与较差的区域控制及风险比显著相关，风险比为2.83（95%置信区间：1.04 - 7.71，P = 0.042）。在CSS多因素分析中，淋巴管间隙侵犯、切缘阳性和淋巴结>2 cm具有显著不良影响。5年时的区域控制、癌症特异性生存和总生存率分别为67%、66%和52%。
皮肤受累在区域复发模式中占主导。使用填充物与明显更差的皮肤反应相关。使用填充物对区域控制并无显著的总体益处。该分析不支持在本队列中使用填充物。
