Chen Allen M, Daly Megan E, Cui Jing, Mathai Mathew, Benedict Stanley, Purdy James A
Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California.
Head Neck. 2014 Nov;36(11):1541-6. doi: 10.1002/hed.23477. Epub 2014 Jan 22.
The purpose of this study was to determine the effect of adaptive replanning on clinical outcome among patients treated by intensity-modulated radiotherapy (IMRT) for head and neck cancer.
Three hundred seventeen patients underwent IMRT with daily image-guidance for newly diagnosed squamous cell carcinoma of the head and neck to a median dose of 66 Gy (range, 60-74 Gy). Of these 317 patients, 51 (16%) underwent adaptive radiotherapy with modification of the original IMRT midway during treatment.
The 2-year local-regional control was 88% for patients treated with adaptive replanning compared with 79% for patients treated without (p = .01). The median time to local-regional recurrence for the 4 patients treated by adaptive radiotherapy was 7 months (range, 3-15 months) with all failures occurring within the high-dose planning target volume (PTV).
Although the use of routine replanning is probably not necessary, our findings do suggest a significant benefit in appropriately selected patients.
本研究的目的是确定自适应重新计划对头颈部癌调强放射治疗（IMRT）患者临床结局的影响。
317例新诊断的头颈部鳞状细胞癌患者接受了每日图像引导的IMRT，中位剂量为66 Gy（范围60 - 74 Gy）。在这317例患者中，51例（16%）在治疗中途对原始IMRT进行了修改，接受了自适应放射治疗。
接受自适应重新计划治疗的患者2年局部区域控制率为88%，未接受自适应重新计划治疗的患者为79%（p = 0.01）。接受自适应放射治疗的4例患者局部区域复发的中位时间为7个月（范围3 - 15个月），所有复发均发生在高剂量计划靶区（PTV）内。
虽然可能没有必要使用常规重新计划，但我们的研究结果确实表明，在适当选择的患者中，自适应重新计划有显著益处。
