全野序贯调强放疗用于局部区域晚期头颈部鳞状细胞癌
Whole-Field Sequential Intensity-Modulated Radiotherapy for Local-Regional Advanced Head-and-Neck Squamous Cell Carcinoma.
作者信息
Refaat Tamer, Choi Mehee, Thomas Tarita O, Bacchus Ian, Agulnik Mark, Pelzer Harold J, Mellott Ann L, Rademaker Alfred W, Liu Dachao, Sathiaseelan Vythialinga, Mittal Bharat B
机构信息
Departments of *Radiation Oncology ‡Medicine, Division of Hematology/Oncology §Otolaryngology, Head and Neck Surgery ∥Preventive Medicine, Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL †Department of Clinical Oncology, Alexandria University, Alexandria, Egypt.
出版信息
Am J Clin Oncol. 2015 Dec;38(6):588-94. doi: 10.1097/COC.0000000000000001.
PURPOSE
There is little published data on the technique and results of whole-field (WF) sequential intensity-modulated radiotherapy (S-IMRT) for patients with head-and-neck squamous cell carcinoma (HNSCC). We report the treatment outcomes, adverse events (AEs), and dosimetric parameters in local-regional advanced (LRA) HNSCC patients treated with the WF S-IMRT technique.
METHODS
The IRB approved this retrospective study. Patients received WF S-IMRT with or without concomitant chemotherapy. Three separate IMRT plans corresponding to 3 planning target volumes were generated. This study reports patient and tumor characteristics, treatment-induced acute AEs based on CTCAE version 3.0, chronic AEs according to RTOG scale and treatment outcomes, local-regional control (LRC), distant metastases (DM), relapse-free survival (RFS), and overall survival (OS).
RESULTS
Between January 2003 and December 2010, 103 patients with LRA HNSCC were treated either definitively or postoperatively with WF S-IMRT, with (99 patients) or without (4 patients) concurrent chemotherapy. The median age was 55 years (range, 30 to 89 y). The median cumulative target dose was 70 Gy (range, 60 to 75 Gy). At a median follow-up of 40 months (range, 4 to 95 mo), the 2- and 5-year rates of OS were 94% and 77%, RFS were 90% and 84%, LRC were 97% and 93%, and DM were 9% and 11%, respectively. Grade 3 acute AEs included mucositis (68%), dysphagia (35%), weight loss (19.6%), and xerostomia (7.8%). Chronic worst grade 3 AEs included xerostomia (21.9%), weight loss (12.8%), and dysphagia (12.5%). Chronic grade 3 AEs at last follow-up included weight loss (6.25%), dysphagia (6.2%), and xerostomia (6.2%). No patient had an acute or chronic grade 4 AE, brachial plexopathy, or spinal cord injury.
CONCLUSIONS
WF S-IMRT results in excellent tumor control and an acceptable toxicity profile in LRA HNSCC patients treated with this technique.
目的
关于头颈部鳞状细胞癌（HNSCC）患者的全野（WF）序贯调强放疗（S-IMRT）技术及结果的已发表数据很少。我们报告采用WF S-IMRT技术治疗的局部区域晚期（LRA）HNSCC患者的治疗结果、不良事件（AE）和剂量学参数。
方法
机构审查委员会批准了这项回顾性研究。患者接受了伴或不伴同步化疗的WF S-IMRT。生成了对应3个计划靶区体积的3个独立IMRT计划。本研究报告患者和肿瘤特征、基于美国国立癌症研究所不良事件通用术语标准第3.0版的治疗引起的急性AE、根据美国放射肿瘤学会（RTOG）标准的慢性AE以及治疗结果、局部区域控制（LRC）、远处转移（DM）、无复发生存期（RFS）和总生存期（OS）。
结果
在2003年1月至2010年12月期间，103例LRA HNSCC患者接受了WF S-IMRT根治性或术后治疗，其中99例患者接受了同步化疗，4例未接受同步化疗。中位年龄为55岁（范围30至89岁）。中位累积靶区剂量为70 Gy（范围60至75 Gy）。中位随访40个月（范围4至95个月）时，OS的2年和5年率分别为94%和77%，RFS分别为90%和84%，LRC分别为97%和9,3%，DM分别为9%和11%。3级急性AE包括黏膜炎（68%）、吞咽困难（35%）、体重减轻（19.6%）和口干（7.8%）。慢性最严重3级AE包括口干（21.9%）、体重减轻（12.8%）和吞咽困难（12.5%）。最后一次随访时的慢性3级AE包括体重减轻（6.25%）、吞咽困难（6.2%）和口干（6.2%）。没有患者发生急性或慢性4级AE、臂丛神经病变或脊髓损伤。
结论
对于采用该技术治疗的LRA HNSCC患者，WF S-IMRT可实现出色的肿瘤控制且毒性特征可接受。
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