Department of Radiation Oncology, Leuvens Kankerinstituut, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
Strahlenther Onkol. 2013 Mar;189(3):223-9. doi: 10.1007/s00066-012-0289-7. Epub 2013 Jan 16.
Intensity-modulated radiotherapy (IMRT) has rapidly become standard of care in the management of locally advanced head and neck squamous cell carcinoma (HNSCC). In this study, our aim was to retrospectively investigate the effect of the introducing IMRT on outcome and treatment-related toxicity compared to parotid-sparing 3D conformal radiotherapy (3DCRT).
A total of 245 patients with stage III and IV HNSCC treated with primary radiotherapy between January 2003 and December 2010 were included in this analysis: 135 patients were treated with 3DCRT, 110 patients with IMRT. Groups were compared for acute and late toxicity, locoregional control (LRC), and overall survival (OS). Oncologic outcomes were estimated using Kaplan-Meier analysis and compared using a log-rank test. Acute toxicity was analyzed according to the Common Terminology Criteria for Adverse Events v3.0 and late toxicity was scored using the RTOG/EORTC late toxicity scoring system.
Median follow-up was 35 months in the IMRT group and 68 months in the 3DCRT group. No significant differences were found in 3-year LRC and OS rates between the IMRT group and 3DCRT group. Significantly less acute mucositis ≥ grade 3 was observed in the IMRT group (32% vs. 44%, p = 0.03). There was significantly less late xerostomia ≥ grade 2 in the IMRT group than in the 3DCRT group (23% vs. 68%, p < 0.001). After 24 months, there was less dysphagia ≥ grade 2 in the IMRT group although differences failed to reach statistical significance.
The introduction of IMRT in the radiotherapeutic management of locally advanced head and neck cancer significantly improved late toxicity without compromising tumor control compared to a parotid-sparing 3D conformal radiotherapy technique.
调强放疗（IMRT）在局部晚期头颈部鳞状细胞癌（HNSCC）的治疗中已迅速成为标准治疗方法。在这项研究中，我们旨在回顾性研究与腮腺保护的三维适形放疗（3DCRT）相比，引入调强放疗对结果和治疗相关毒性的影响。
共纳入 245 例 2003 年 1 月至 2010 年 12 月期间接受根治性放疗的 III 期和 IV 期 HNSCC 患者：135 例接受 3DCRT 治疗，110 例接受 IMRT 治疗。比较两组的急性和晚期毒性、局部区域控制（LRC）和总生存（OS）。使用 Kaplan-Meier 分析估计肿瘤学结果，并使用对数秩检验进行比较。根据不良事件常用术语标准 v3.0 分析急性毒性，使用 RTOG/EORTC 晚期毒性评分系统对晚期毒性进行评分。
IMRT 组的中位随访时间为 35 个月，3DCRT 组为 68 个月。IMRT 组与 3DCRT 组 3 年 LRC 和 OS 率无显著差异。IMRT 组 3 级以上急性黏膜炎发生率明显低于 3DCRT 组（32% vs. 44%，p=0.03）。IMRT 组晚期口干症≥2 级的发生率明显低于 3DCRT 组（23% vs. 68%，p<0.001）。24 个月后，IMRT 组的吞咽困难≥2 级发生率较低，但差异无统计学意义。
与腮腺保护的三维适形放疗技术相比，局部晚期头颈部癌症放射治疗中引入调强放疗可显著改善晚期毒性，而不影响肿瘤控制。
