局部晚期头颈癌姑息治疗的周期性大分割放疗技术：机构经验及姑息治疗方案综述
Cyclical hypofractionated radiotherapy technique for palliative treatment of locally advanced head and neck cancer: institutional experience and review of palliative regimens.
作者信息
Finnegan Teresa S, Bhatt Neal H, Shaughnessy Joseph N, Perez Cesar, Redman Rebecca, Silverman Craig, Bumpous Jeffrey, Potts Kevin, Dunlap Neal E
机构信息
University of Louisville School of Medicine, Louisville, Kentucky, USA.
University of Louisville Brown Cancer Center, Department of Radiation Oncology, Louisville, Kentucky, USA.
出版信息
J Community Support Oncol. 2016 Jan;14(1):29-36. doi: 10.12788/jcso.0201.
BACKGROUND
Effective palliation in patients with locally advanced head and neck cancer is important. Cyclical hypofractionated radiotherapy (Quad Shot) is a short-course palliative regimen with good patient compliance, low rates of acute toxicity, and delayed late fibrosis.
OBJECTIVE
To review use of the Quad Shot technique at our institution in order to quantify the palliative response in locally advanced head and neck cancer.
METHODS
The medical records of 70 patients with head and neck squamous cell carcinoma who had been treated with the Quad Shot technique were analyzed retrospectively (36 had been treated with intensity-modulated radiation therapy and 34 with 3-D conformal radiotherapy). They had received cyclical hypofractionated radiotherapy administrated as 14.8 Gy in 4 fractions over 2 days, twice daily, repeated every 3 weeks for a total of 3 cycles. The total prescribed dose was 44.4 Gy. Primary endpoints were improvement in pain using a verbal numeric pain rating scale (range 1-10, 10 being severe pain) and dysphagia using the Food Intake Level Scale, and the secondary endpoints included overall survival (OS), local regional recurrence-free survival (LRRFS), progression-free survival (PFS) and time to progression.
RESULTS
Pain response occurred in 61% of the patients. The mean pain scores decreased significantly from pre to post treatment (5.81 to 2.55, 𝑃 = .009). The mean initial dysphagia score improved from 2.20 to 4.77 55 (𝑃 = .045). 26% of patients developed mucositis (≤ grade 2), with 9% developing grade 3-level mucositis. 12 patients had tumor recurrence. The estimated 1-year PFS was 20.7%. The median survival was 3.85 months with an estimated 1-year OS of 22.6%. Pain response (hazard ratio [HR], 2.69; 95% confidence index [CI], I.552-1.77) and completion of all 3 cycles (HR, 1.71; 95% CI, 1.003-2.907) were predictive for improved OS.
LIMITATIONS
This study is a retrospective analysis.
CONCLUSION
Quad Shot is an appropriate palliative regimen for locally advanced head and neck cancer.
背景
对局部晚期头颈癌患者进行有效的姑息治疗很重要。周期性大分割放疗（四程放疗）是一种短程姑息治疗方案，患者依从性好，急性毒性发生率低，晚期纤维化延迟发生。
目的
回顾我院四程放疗技术的应用情况，以量化局部晚期头颈癌的姑息治疗反应。
方法
回顾性分析70例接受四程放疗技术治疗的头颈鳞状细胞癌患者的病历（36例接受调强放疗，34例接受三维适形放疗）。他们接受了周期性大分割放疗，在2天内分4次给予14.8 Gy，每天2次，每3周重复一次，共3个周期。总处方剂量为44.4 Gy。主要终点是使用言语数字疼痛评分量表（范围1-10，10为剧痛）评估疼痛改善情况，以及使用食物摄入水平量表评估吞咽困难改善情况，次要终点包括总生存期（OS）、局部区域无复发生存期（LRRFS）、无进展生存期（PFS）和疾病进展时间。
结果
61%的患者出现疼痛反应。治疗前后平均疼痛评分显著降低（5.81至2.55，P = 0.009）。平均初始吞咽困难评分从2.20提高到4.77（P = 0.045）。26%的患者发生黏膜炎（≤2级），9%的患者发生3级黏膜炎。12例患者出现肿瘤复发。估计1年PFS为20.7%。中位生存期为3.85个月，估计1年OS为22.6%。疼痛反应（风险比[HR]，2.69；95%置信区间[CI]，1.552-1.77）和完成所有3个周期（HR，1.71；95%CI，1.003-2.907）可预测OS改善。
局限性
本研究为回顾性分析。
结论
四程放疗是局部晚期头颈癌合适的姑息治疗方案。
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