Cvek Jakub, Knybel Lukas, Skacelikova Eva, Stransky Jiri, Matousek Petr, Zelenik Karol, Res Oldrich, Otahal Bretislav, Molenda Lukas, Feltl David
Department of Oncology, University Hospital Ostrava, listopadu 1790, 708 52, Ostrava, Czech Republic.
Department of Maxilofacial Surgery, University Hospital Ostrava, Ostrava, Czech Republic.
Strahlenther Onkol. 2016 Jan;192(1):40-6. doi: 10.1007/s00066-015-0886-3. Epub 2015 Aug 28.
The goal of this work was to evaluate the efficacy and toxicity of hyperfractionated stereotactic reirradiation (re-RT) as a treatment for inoperable, recurrent, or second primary head and neck squamous cell cancer (HNSCC) that is not suitable for systemic treatment.
Forty patients with recurrent or second primary HNSCC were included in this study. The patients had a median gross tumor volume of 76 ml (range 14-193 ml) and a previous radiotherapy dose greater than 60 Gy. Treatment was designed to cover 95 % of the planning target volume (PTV, defined as gross tumor volume [GTV] + 3 mm to account for microscopic spreading, with no additional set-up margin) with the prescribed dose (48 Gy in 16 fractions b.i.d.). Treatment was administered twice daily with a minimum 6 h gap. Uninvolved lymph nodes were not irradiated.
Treatment was completed as planned for all patients (with median duration of 11 days, range 9-14 days). Acute toxicity was evaluated using the RTOG/EORTC scale. A 37 % incidence of grade 3 mucositis was observed, with recovery time of ≤ 4 weeks for all of these patients. Acute skin toxicity was never observed to be higher than grade 2. Late toxicity was also evaluated according to the RTOG/EORTC scale. Mandible radionecrosis was seen in 4 cases (10 %); however, neither carotid blowout syndrome nor other grade 4 late toxicity occurred. One-year overall survival (OS) and local progression-free survival (L-PFS) were found to be 33 and 44 %, respectively. Performance status and GTV proved to be significant prognostic factors regarding local control and survival.
Hyperfractionated stereotactic re-RT is a reasonable treatment option for patients with recurrent/second primary HNSCC who were previously exposed to high-dose irradiation and who are not candidates for systemic treatment or hypofractionation.
本研究旨在评估超分割立体定向再程放疗（再放疗）治疗无法手术、复发或第二原发性头颈部鳞状细胞癌（HNSCC）且不适合全身治疗的疗效和毒性。
本研究纳入了40例复发或第二原发性HNSCC患者。患者的中位大体肿瘤体积为76 ml（范围14 - 193 ml），既往放疗剂量大于60 Gy。治疗计划覆盖95%的计划靶体积（PTV，定义为大体肿瘤体积[GTV] + 3 mm以考虑微观扩散，无额外的摆位边界），处方剂量为48 Gy，分16次，每日两次。每天治疗两次，间隔至少6小时。未累及的淋巴结不进行照射。
所有患者均按计划完成治疗（中位疗程为11天，范围9 - 14天）。使用RTOG/EORTC量表评估急性毒性。观察到37%的患者发生3级黏膜炎，所有这些患者的恢复时间≤4周。从未观察到急性皮肤毒性高于2级。晚期毒性也根据RTOG/EORTC量表进行评估。4例（10%）出现下颌骨放射性坏死；然而，未发生颈动脉破裂综合征或其他4级晚期毒性。1年总生存率（OS）和局部无进展生存率（L - PFS）分别为33%和44%。体能状态和GTV被证明是局部控制和生存的重要预后因素。
超分割立体定向再放疗是复发/第二原发性HNSCC患者的一种合理治疗选择，这些患者既往接受过高剂量照射，且不适合全身治疗或大分割放疗。
