Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Int J Radiat Oncol Biol Phys. 2014 Aug 1;89(5):981-988. doi: 10.1016/j.ijrobp.2014.04.024. Epub 2014 Jun 10.
A subset of patients with oropharyngeal squamous cell carcinoma (OP-SCC) managed with transoral robotic surgery (TORS) and postoperative radiation therapy (PORT) developed soft tissue necrosis (STN) in the surgical bed months after completion of PORT. We investigated the frequency and risk factors.
This retrospective analysis included 170 consecutive OP-SCC patients treated with TORS and PORT between 2006 and 2012, with >6 months' of follow-up. STN was defined as ulceration of the surgical bed >6 weeks after completion of PORT, requiring opioids, biopsy, or hyperbaric oxygen therapy.
A total of 47 of 170 patients (28%) had a diagnosis of STN. Tonsillar patients were more susceptible than base-of-tongue (BOT) patients, 39% (41 of 104) versus 9% (6 of 66), respectively. For patients with STN, median tumor size was 3.0 cm (range 1.0-5.6 cm), and depth of resection was 2.2 cm (range 1.0-5.1 cm). Median radiation dose and dose of fraction to the surgical bed were 6600 cGy and 220 cGy, respectively. Thirty-one patients (66%) received concurrent chemotherapy. Median time to STN was 2.5 months after PORT. All patients had resolution of STN after a median of 3.7 months. Multivariate analysis identified tonsillar primary (odds ratio [OR] 4.73, P=.01), depth of resection (OR 3.12, P=.001), total radiation dose to the resection bed (OR 1.51 per Gy, P<.01), and grade 3 acute mucositis (OR 3.47, P=.02) as risk factors for STN. Beginning May 2011, after implementing aggressive avoidance of delivering >2 Gy/day to the resection bed mucosa, only 8% (2 of 26 patients) experienced STN (all grade 2).
A subset of OP-SCC patients treated with TORS and PORT are at risk for developing late consequential surgical bed STN. Risk factors include tonsillar location, depth of resection, radiation dose to the surgical bed, and severe mucositis. STN risk is significantly decreased with carefully avoiding a radiation dosage of >2 Gy/day to the surgical bed.
接受经口机器人手术（TORS）和术后放疗（PORT）治疗的口咽鳞状细胞癌（OP-SCC）患者中有一部分在 PORT 完成数月后发生手术床软组织坏死（STN）。我们对此进行了研究，并分析了其发生频率和危险因素。
本回顾性分析纳入了 2006 年至 2012 年间接受 TORS 和 PORT 治疗的 170 例连续 OP-SCC 患者，随访时间均超过 6 个月。STN 定义为 PORT 完成后超过 6 周出现手术床溃疡，需要使用阿片类药物、活检或高压氧治疗。
170 例患者中共有 47 例（28%）诊断为 STN。扁桃体患者比舌根患者更容易发生 STN，分别为 39%（41/104）和 9%（6/66）。发生 STN 的患者肿瘤最大径中位数为 3.0 cm（范围 1.0-5.6 cm），切缘深度中位数为 2.2 cm（范围 1.0-5.1 cm）。中位放疗剂量和手术床分割剂量分别为 6600 cGy 和 220 cGy。31 例（66%）患者接受了同期化疗。STN 中位发生时间为 PORT 后 2.5 个月。所有患者在中位 3.7 个月后 STN 均得到缓解。多因素分析发现扁桃体原发肿瘤（比值比 [OR] 4.73，P=.01）、切缘深度（OR 3.12，P=.001）、手术床总放疗剂量（OR 每 Gy 增加 1.51，P<.01）和 3 级急性黏膜炎（OR 3.47，P=.02）是 STN 的危险因素。自 2011 年 5 月起，开始积极避免将 2 Gy/天以上的剂量用于手术床黏膜，仅 8%（26 例患者中的 2 例）发生 STN（均为 2 级）。
接受 TORS 和 PORT 治疗的 OP-SCC 患者中，有一部分存在发生晚期手术床 STN 的风险。危险因素包括扁桃体位置、切缘深度、手术床放疗剂量和严重黏膜炎。通过仔细避免手术床接受超过 2 Gy/天的放疗剂量，可显著降低 STN 风险。
