Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven, Belgium.
Department of Radiation Oncology, Ghent University Hospital, Belgium.
Radiother Oncol. 2017 Jun;123(3):419-423. doi: 10.1016/j.radonc.2017.03.003. Epub 2017 Mar 22.
To investigate the patterns of regional recurrences with emphasis on recurrences in the electively irradiated lymph node regions after dose de-escalation to 40Gy (EQD2Gy) in head and neck cancer.
Two hundred thirty-three patients treated with radio(chemo)therapy using 40Gy (EQD2Gy) to the elective lymph node regions were included. All regional recurrences were reconstructed and projected on the initial radiotherapy planning Computed Tomography studies to identify the localization of recurrence. Furthermore, patient and treatment characteristics were correlated with the regional recurrences to identify risk factors.
The median follow-up in our study was 26months. Overall- and disease-specific survival at 2years were 71.2% (95% CI 65.3-77.1) and 64.2% (95% CI 59.2-69.3), respectively. Local, regional and distant control at 2years was 84.1% (95% CI 79.1-89.2), 89.2% (95% CI 84.3-94.1) and 83.2% (95% CI 76.3-90.1), respectively. Twenty-eight patients experienced a regional recurrence. Fourteen of these patients had a recurrence within the high dose volume (14 of 28). Nine had a recurrence in the electively irradiated lymph node regions (9 of 28) and 5 recurrences occurred outside the target volume. The actuarial rate of recurrence in the electively irradiated lymph node regions was 3.9% (95% CI 1.8-6.0) at 2years. No significant associations could be observed between recurrence in electively irradiated lymph node regions and age, gender, tumor site, stage, or the presence of human papillomavirus in oropharyngeal cancers.
The actuarial rate of recurrence in the electively irradiated lymph node regions was 3.9% (95% CI 1.8-6.0) at 2years. This incidence is comparable to recurrence rates after standard dose of 50Gy, suggesting that lower doses to the elective neck do not result in higher regional recurrences.
研究头颈部癌调强放疗剂量降低至 40Gy（EQD2Gy）后，选择性照射淋巴结区域局部复发的模式，重点分析选择性照射淋巴结区域的局部复发情况。
本研究纳入了 233 例接受放化疗的患者，采用 40Gy（EQD2Gy）照射选择性淋巴结区域。所有局部复发均在初始放疗计划 CT 研究上进行重建和投影，以确定复发部位。此外，还对患者和治疗特征与局部复发进行相关性分析，以确定危险因素。
本研究的中位随访时间为 26 个月。2 年时的总生存率和疾病特异性生存率分别为 71.2%（95%CI 65.3-77.1）和 64.2%（95%CI 59.2-69.3）。2 年时的局部、区域和远处控制率分别为 84.1%（95%CI 79.1-89.2）、89.2%（95%CI 84.3-94.1）和 83.2%（95%CI 76.3-90.1）。28 例患者出现区域复发。其中 14 例患者在高剂量体积内复发（28 例中 14 例），9 例患者在选择性照射淋巴结区域内复发（28 例中 9 例），5 例患者在靶区外复发。2 年内选择性照射淋巴结区域的累积复发率为 3.9%（95%CI 1.8-6.0）。在选择性照射淋巴结区域内复发与年龄、性别、肿瘤部位、分期或口咽癌中是否存在人乳头瘤病毒之间无显著相关性。
2 年内选择性照射淋巴结区域的累积复发率为 3.9%（95%CI 1.8-6.0）。这一发生率与 50Gy 标准剂量的复发率相当，表明颈部选择性低剂量照射不会导致更高的区域复发率。
