头颈部癌采用缩小计划靶区边缘及每日图像引导的调强放疗的长期经验。
Long-term experience with reduced planning target volume margins and intensity-modulated radiotherapy with daily image-guidance for head and neck cancer.
作者信息
Chen Allen M, Yu Yao, Daly Megan E, Farwell D Gregory, Benedict Stanley H, Purdy James A
机构信息
Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California.
出版信息
Head Neck. 2014 Dec;36(12):1766-72. doi: 10.1002/hed.23532. Epub 2014 Mar 25.
BACKGROUND
The purpose of this study was to compare outcomes among patients treated by intensity-modulated radiotherapy (IMRT) with daily image-guided radiotherapy (IGRT) for head and neck cancer according to the margins used to expand the clinical target volume (CTV) to create a planning target volume (PTV).
METHODS
Three hundred sixty-seven consecutive patients were treated with IMRT for squamous cell carcinoma of the head and neck. The first 103 patients were treated with 5-mm CTV-to-PTV margins. The subsequent 264 patients were treated using reduced (3 mm) margins.
RESULTS
The 3-year locoregional control for patients treated using 5-mm and 3-mm CTV-to-PTV margins, respectively, was 78% and 80% (p = .75). The incidence of gastrostomy-tube dependence at 1 year was 10% and 3%, respectively (p = .001). The incidence of posttreatment esophageal stricture was 14% and 7%, respectively (p = .01).
CONCLUSION
The use of reduced (3 mm) CTV-to-PTV margins was associated with reduced late toxicity while maintaining locoregional control.
背景
本研究的目的是根据用于将临床靶体积（CTV）扩展以创建计划靶体积（PTV）的边界，比较采用调强放疗（IMRT）联合每日图像引导放疗（IGRT）治疗的头颈癌患者的治疗结果。
方法
367例连续性头颈鳞状细胞癌患者接受了IMRT治疗。前103例患者采用CTV至PTV 5毫米的边界进行治疗。随后的264例患者采用缩小（3毫米）的边界进行治疗。
结果
采用CTV至PTV 5毫米和3毫米边界治疗的患者，其3年局部区域控制率分别为78%和80%（p = 0.75）。1年时胃造瘘管依赖发生率分别为10%和3%（p = 0.001）。治疗后食管狭窄发生率分别为14%和7%（p = 0.01）。
结论
采用缩小（3毫米）的CTV至PTV边界与降低晚期毒性相关，同时维持局部区域控制。
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