Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, United States.
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, United States.
Radiother Oncol. 2014 Jun;111(3):382-7. doi: 10.1016/j.radonc.2014.06.003. Epub 2014 Jun 30.
Loco-regionally recurrent head and neck cancer (HNC) in the setting of prior radiotherapy carries significant morbidity and mortality. The role of re-irradiation (re-RT) remains unclear due to toxicity. We determined prognostic factors for loco-regional control (LRC) and formulated a nomogram to help clinicians select re-RT candidates.
From July 1996 to April 2011, 257 patients with recurrent HNC underwent fractionated re-RT. Median prior dose was 65 Gy and median time between RT was 32.4 months. One hundred fifteen patients (44%) had salvage surgery and 172 (67%) received concurrent chemotherapy. Median re-RT dose was 59.4 Gy and 201 (78%) patients received IMRT. Multivariate Cox proportional hazards were used to identify independent predictors of LRC and a nomogram for 2-year LRC was constructed.
Median follow-up was 32.6 months. Two-year LRC and overall survival (OS) were 47% and 43%, respectively. Recurrent stage (P=0.005), non-oral cavity subsite (P<0.001), absent organ dysfunction (P<0.001), salvage surgery (P<0.001), and dose >50 Gy (P=0.006) were independently associated with improved LRC. We generated a nomogram with concordance index of 0.68.
Re-RT can be curative, and our nomogram can help determine a priori which patients may benefit.
先前接受过放射治疗的局部复发性头颈部癌症（HNC）患者具有显著的发病率和死亡率。由于毒性，再照射（re-RT）的作用仍不清楚。我们确定了局部区域控制（LRC）的预后因素，并制定了列线图，以帮助临床医生选择 re-RT 候选者。
1996 年 7 月至 2011 年 4 月，257 例复发性 HNC 患者接受了分次 re-RT。中位既往剂量为 65Gy，放疗之间的中位时间为 32.4 个月。115 例（44%）患者行挽救性手术，172 例（67%）患者接受同期化疗。中位 re-RT 剂量为 59.4Gy，201 例（78%）患者接受了调强放疗。多变量 Cox 比例风险用于确定 LRC 的独立预测因素，并构建了 2 年 LRC 的列线图。
中位随访时间为 32.6 个月。2 年 LRC 和总生存率（OS）分别为 47%和 43%。复发性分期（P=0.005）、非口腔部位（P<0.001）、无器官功能障碍（P<0.001）、挽救性手术（P<0.001）和剂量>50Gy（P=0.006）与改善 LRC 独立相关。我们生成了一个一致性指数为 0.68 的列线图。
re-RT 可以是治愈性的，我们的列线图可以帮助预先确定哪些患者可能受益。
