Department of Radiation Oncology, University Hospital Zurich, Rämistr. 1000, 8091, Zurich, Switzerland.
Strahlenther Onkol. 2014 Apr;190(4):386-93. doi: 10.1007/s00066-013-0508-x. Epub 2014 Feb 7.
The goal of the present study was to evaluate the outcome of risk-adapted planning treatment volumes (PTVs) in patients with cervical lymph node metastases of unknown primary cancer (UPC) treated with intensity-modulated radiotherapy (IMRT).
Between January 2006 and November 2012, 28 patients with cervical lymph node metastases of UPC were treated in our institution with IMRT either postoperatively (n = 20) or as definitive treatment (n = 8). Nodal involvement distributed as follows: N1 (n = 2), N2a (8), N2b (10), N2c (4), and N3 (4). Systemic therapy with cisplatin or cetuximab was added concomitantly in 20 of 28 patients (71 %). Radiotherapy using simultaneously integrated boost (SIB-IMRT) was carried out with 2.0 or 2.11 Gy single doses up to 66/70 Gy.
Mean/median follow-up was 31.6/30.5 months (range 3-78 months). In all, 15 of 28 patients were treated with unilateral SIB-IMRT (54 %). An elective PTV to the contralateral oropharynx and contralateral level II-III lymph nodes was carried out in 8 patients with PET-CT suspected but not histologically proven involvement, recurrences or former tumor of the oropharynx. More extended treatment fields were reserved for patients with N2c or bilaterally N3 status (n = 5). The 3-year overall survival, mucosal control, neck control and distant metastasis-free survival rates were 76, 100, 93, and 88 %, respectively. No patient suffered from a locoregional recurrence. Two patients treated with radiotherapy alone had persistent nodal disease. No grade II or higher late sequel has been observed.
Our single center approach to treat patients with cervical lymph node metastases of UPC with individualized, risk-adapted SIB-IMRT resulted in high locoregional tumor control and was well tolerated.
本研究旨在评估针对不明原发灶颈部淋巴结转移癌（UPC）患者采用调强放疗（IMRT）进行风险适应治疗靶区（PTV）的治疗结果。
在 2006 年 1 月至 2012 年 11 月期间，我们机构对 28 例 UPC 颈部淋巴结转移患者采用 IMRT 进行治疗，其中 20 例为术后治疗，8 例为根治性治疗。淋巴结受累分布如下：N1（n=2）、N2a（n=8）、N2b（n=10）、N2c（n=4）和 N3（n=4）。28 例患者中有 20 例（71%）同时接受顺铂或西妥昔单抗系统治疗。2.0 或 2.11 Gy 单次剂量的同步整合推量（SIB-IMRT）放疗达到 66/70 Gy。
中位随访时间为 31.6 个月（范围 3-78 个月）。28 例患者中，15 例采用单侧 SIB-IMRT（54%）。8 例患者在 PET-CT 怀疑但未经组织学证实有累及、复发或先前的口咽肿瘤的情况下，对患侧或咽和对侧 II-III 水平淋巴结进行了选择性 PTV 照射。对于 N2c 或双侧 N3 状态的患者（n=5），保留了更广泛的治疗野。3 年总生存率、黏膜控制率、颈部控制率和无远处转移生存率分别为 76%、100%、93%和 88%。没有患者发生局部区域复发。2 例单独接受放疗的患者存在持续性淋巴结疾病。未观察到 II 级或更高级别的迟发性后遗症。
我们机构采用个体化风险适应 SIB-IMRT 治疗 UPC 颈部淋巴结转移患者的单中心方法，实现了高局部肿瘤控制，且患者耐受性良好。
