头颈部癌的再程放疗：长期疾病控制与毒性反应
Reirradiation of head and neck cancer: Long-term disease control and toxicity.
作者信息
Bots Wouter T C, van den Bosch Sven, Zwijnenburg Ellen M, Dijkema Tim, van den Broek Guido B, Weijs Willem L J, Verhoef Lia C G, Kaanders Johannes H A M
机构信息
Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Otorhinolaryngology Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
出版信息
Head Neck. 2017 Jun;39(6):1122-1130. doi: 10.1002/hed.24733. Epub 2017 Mar 6.
BACKGROUND
The purpose of this study was to report long-term disease control and late radiation toxicity for patients reirradiated for head and neck cancer.
METHODS
We conducted a retrospective analysis of 137 patients reirradiated with a prescribed dose ≥45 Gy between 1986 and 2013 for a recurrent or second primary malignancy. Endpoints were locoregional control, overall survival (OS), and grade ≥4 late complications according to European Organization for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) criteria.
RESULTS
Five-year locoregional control rates were 46% for patients reirradiated postoperatively versus 20% for patients who underwent reirradiation as the primary treatment (p < .05). Sixteen cases of serious (grade ≥4) late toxicity were seen in 11 patients (actuarial 28% at 5 years). In patients reirradiated with intensity-modulated radiotherapy (IMRT), a borderline improved locoregional control was observed (49% vs 36%; p = .07), whereas late complication rates did not differ.
CONCLUSION
Reirradiation should be considered for patients with a recurrent or second primary head and neck cancer, especially postoperatively, if indicated. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1122-1130, 2017.
背景
本研究旨在报告接受头颈部癌再程放疗患者的长期疾病控制情况及晚期放射毒性。
方法
我们对1986年至2013年间因复发性或第二原发性恶性肿瘤接受≥45 Gy处方剂量再程放疗的137例患者进行了回顾性分析。终点指标为局部区域控制、总生存期（OS）以及根据欧洲癌症研究与治疗组织（EORTC）/放射肿瘤学组（RTOG）标准判定的≥4级晚期并发症。
结果
术后接受再程放疗患者的5年局部区域控制率为46%，而接受再程放疗作为初始治疗的患者为20%（p <.05）。11例患者出现16例严重（≥4级）晚期毒性反应（5年精算发生率为28%）。在接受调强放疗（IMRT）再程放疗的患者中，观察到局部区域控制有边际性改善（49%对36%；p = 0.07），而晚期并发症发生率无差异。
结论
对于复发性或第二原发性头颈部癌患者，尤其是术后患者，若有指征，应考虑再程放疗。© 2017威利期刊公司。《头颈》39: 1122 - 1130, 2017。
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