Lee Yun Hee, Kim Yeon Sil, Chung Mi Joo, Yu Mina, Jung So Lyung, Yoo Ie Ryung, Lee Youn Soo, Kim Min Sik, Sun Dong Il, Kang Jin Hyung
From the Department of Radiation Oncology (YHL), Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Departments of Radiation Oncology (YSK), Radiology (SLJ), Nuclear medicine (IRY), Pathology (YSL), Otorhinolaryngology (MSK, DIS), Medical Oncology (JHK), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, Department of Radiation Oncology (MJC), Kyung Hee University Hospital at Gangdong, Seoul, South Korea, and Department of Radiation Oncology (MY), Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
Medicine (Baltimore). 2016 Mar;95(9):e2852. doi: 10.1097/MD.0000000000002852.
Risk factors were evaluated for surgical bed soft tissue necrosis (STN) in head and neck cancer patients treated with postoperative radiation therapy (PORT) after transoral robotic surgery (TORS) or wide excision with primary closure. Sixty-seven patients were evaluated. STN was defined as ulceration and necrosis of the surgical bed or persistently unhealed high-grade acute mucositis with pain after PORT. The median RT dose of primary site was 63.6 Gy (range, 45-67.15 Gy) with 2 Gy/fx (range 1.8-2.2 Gy/fx). Total 41 patients (61.2%) were treated with concurrent chemoradiotherapy. The median follow-up period was 26 months. STN was diagnosed in 13 patients (19.4%). Most of the patients were treated with oral steroids, antibiotics, and analgesics and the lesions were eventually improved (median of 6 months after PORT). STN did not influence local control. A depth of invasion (DOI > 1.4 cm, odds ratio [OR] 14.04, p = 0.004) and maximum dose/fraction (CTVpmax/fx > 2.3 Gy, OR 6.344, p = 0.043) and grade 3 acute mucositis (OR 6.090, p = 0.054) were related to STN. The 12 (23.5%) of 51 oropharyngeal cancer patients presented STN, and the risk factors were DOI > 1.2 cm (OR 21.499, P = 0.005), CTVpmax/fx > 2.3 Gy (OR 12.972, P = 0.021) and grade 3 acute mucositis (OR 10.537, P = 0.052). Patients treated with TORS or WE with primary closure followed by PORT had a high risk of surgical bed STN. STN risk factors included DOI (>1.2-1.4 cm) and CTVpmax/fx (>2.3 Gy). Radiation therapy after TORS must be carefully designed to prevent STN.
对接受经口机器人手术（TORS）或广泛切除并一期缝合术后辅助放疗（PORT）的头颈癌患者，评估手术床软组织坏死（STN）的危险因素。共评估了67例患者。STN定义为手术床溃疡和坏死，或PORT后持续不愈合的重度急性粘膜炎伴疼痛。原发部位的中位放疗剂量为63.6 Gy（范围45 - 67.15 Gy），每次分割剂量2 Gy（范围1.8 - 2.2 Gy/fx）。共有41例患者（61.2%）接受同步放化疗。中位随访期为26个月。13例患者（19.4%）被诊断为STN。大多数患者接受了口服类固醇、抗生素和镇痛药治疗，病变最终得到改善（PORT后中位6个月）。STN不影响局部控制。肿瘤浸润深度（DOI＞1.4 cm，比值比[OR] 14.04，p = 0.004）、最大剂量/分割（CTVpmax/fx＞2.3 Gy，OR 6.344，p = 0.043）和3级急性粘膜炎（OR 6.090，p = 0.054）与STN相关。51例口咽癌患者中有12例（23.5%）出现STN，危险因素为DOI＞1.2 cm（OR 21.499，P = 0.005）、CTVpmax/fx＞2.3 Gy（OR 12.972，P = 0.021）和3级急性粘膜炎（OR 10.537，P = 0.052）。接受TORS或广泛切除并一期缝合后再行PORT治疗的患者，手术床STN风险较高。STN的危险因素包括DOI（＞1.2 - 1.4 cm）和CTVpmax/fx（＞2.3 Gy）。TORS后的放疗必须精心设计以预防STN。
