Van Gestel Dirk, Van den Weyngaert Danielle, De Kerf Geert, De Ost Bie, Vanderveken Olivier, Van Laer Carl, Specenier Pol, Geussens Yasmyne, Wouters Kristien, Meulemans Els, Cheung Kin Jip, Grégoire Vincent, Vermorken Jan B
Department of Radiotherapy, University Radiotherapy Antwerp UZA/ZNA, Antwerp, Belgium; Department of Otolaryngology and Head and Neck Surgery, Department of Medical Oncology, Scientific Coordination and Biostatistics, and Data-Management Multidisciplinair Oncologisch Centrum Antwerpen, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Iridium Kankernetwerk, Campus Nikolaas, Sint Niklaas, Belgium; Radiation Oncology Department and Centre for Molecular Imaging and Experimental Radiotherapy, St-Luc University Hospital, Brussels, Belgium
Department of Radiotherapy, University Radiotherapy Antwerp UZA/ZNA, Antwerp, Belgium; Department of Otolaryngology and Head and Neck Surgery, Department of Medical Oncology, Scientific Coordination and Biostatistics, and Data-Management Multidisciplinair Oncologisch Centrum Antwerpen, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Iridium Kankernetwerk, Campus Nikolaas, Sint Niklaas, Belgium; Radiation Oncology Department and Centre for Molecular Imaging and Experimental Radiotherapy, St-Luc University Hospital, Brussels, Belgium.
Oncologist. 2015 Mar;20(3):279-90. doi: 10.1634/theoncologist.2014-0337. Epub 2015 Feb 11.
We report on a retrospective analysis of 147 patients with early and locoregionally advanced squamous cell head and neck cancer (SCCHN) treated with helical tomotherapy (HT).
Included were patients with SCCHN of the oral cavity (OC), oropharynx (OP), hypopharynx (HP), or larynx (L) consecutively treated in one radiotherapy center in 2008 and 2009. The prescribed HT dose was 60-66 Gy in the postoperative setting (group A) and 66-70 Gy when given as primary treatment (group B). HT was given alone, concurrent with systemic therapy (ST), that is, chemotherapy, biotherapy, or both, and with or without induction therapy (IT). Acute and late toxicities are reported using standard criteria; locoregional failure/progression (LRF), distant metastases (DM), and second primary tumors (SPT) were documented, and event-free survival (EFS) and overall survival (OS) were calculated from the start of HT.
Group A patients received HT alone in 22 cases and HT + ST in 20 cases; group B patients received HT alone in 17 cases and HT + ST in 88 cases. Severe (grade ≥ 3) acute mucosal toxicity and swallowing problems increased with more additional ST. After a median follow-up of 44 months, grade ≥2 late toxicity after HT + ST was approximately twice that of HT alone for skin, subcutis, pharynx, and larynx. Forty percent had grade ≥2 late xerostomia, and 29% had mucosal toxicity. At 3 years, LRF/DM/SPT occurred in 7%/7%/17% and 25%/13%/5% in groups A and B, respectively, leading to a 3-year EFS/OS of 64%/74% and 56%/63% in groups A and B, respectively.
The use of HT alone or in combination with ST is feasible and promising and has a low late fatality rate. However, late toxicity is nearly twice as high when ST is added to HT.
我们报告了对147例接受螺旋断层放射治疗（HT）的早期和局部区域晚期头颈部鳞状细胞癌（SCCHN）患者的回顾性分析。
纳入的患者为2008年和2009年在一个放疗中心连续接受治疗的口腔（OC）、口咽（OP）、下咽（HP）或喉（L）的SCCHN患者。术后HT的处方剂量为60 - 66 Gy（A组），作为初始治疗时为66 - 70 Gy（B组）。HT单独使用，或与全身治疗（ST）即化疗、生物治疗或两者同时使用，且使用或不使用诱导治疗（IT）。使用标准标准报告急性和晚期毒性；记录局部区域失败/进展（LRF）、远处转移（DM）和第二原发性肿瘤（SPT），并从HT开始计算无事件生存期（EFS）和总生存期（OS）。
A组患者22例单独接受HT，20例接受HT + ST；B组患者17例单独接受HT，88例接受HT + ST。严重（≥3级）急性黏膜毒性和吞咽问题随着更多的额外ST而增加。中位随访44个月后，HT + ST后≥2级晚期毒性在皮肤、皮下组织、咽部和喉部约为单独HT的两倍。40%的患者有≥2级晚期口干，29%的患者有黏膜毒性。3年时，A组和B组的LRF/DM/SPT发生率分别为7%/7%/17%和25%/13%/5%，导致A组和B组的3年EFS/OS分别为64%/74%和56%/63%。
单独使用HT或与ST联合使用是可行且有前景的，晚期死亡率较低。然而，当在HT中加入ST时，晚期毒性几乎高出一倍。
