Gebhardt Brian J, Ohr James P, Ferris Robert L, Duvvuri Umamaheswar, Kim Seungwon, Johnson Jonas T, Heron Dwight E, Clump David A
Departments of Radiation Oncology, Cancer Institute.
Medicine, Division of Medical Oncology.
Am J Clin Oncol. 2018 Sep;41(9):888-893. doi: 10.1097/COC.0000000000000386.
Adjuvant radiation therapy (RT) is indicated for patients with salivary gland malignancies with risk factors for recurrence following resection. We analyzed patients treated with adjuvant RT with or without concurrent chemotherapy to determine the impact of prognostic and treatment factors.
Retrospective analysis was performed of 128 patients treated with surgical resection followed by intensity-modulated radiotherapy. In total, 31 (24.2%) patients were treated with concurrent chemoradiotherapy. The Kaplan-Meier method was used to estimate rates of progression-free survival (PFS), local-regional control, distant control, overall survival. Multivariable Cox regression was performed to evaluate factors significant on univariate analysis.
The 5-year rates of PFS, local-regional control, freedom-from distant metastasis, and overall survival were 61.2%, 85.8%, 76.5%, and 73.7%, respectively. Predictors of decreased PFS on univariate analyses were age, tumor stage, nodal stage, positive surgical margins, histology, high grade, perineural invasion, lymphovascular space invasion, extranodal extension, and use of chemoradiotherapy. On multivariable analysis, elevated T-stage, positive surgical margins, and presence of extranodal extension were predictive of decreased PFS. The acute toxicity rates were 30.3% grade 1, 51.5% grade 2, 11.4% grade 3, and 0.8% grade 4. There was no difference in rates of grade 3 or higher acute toxicity with use of RT alone versus chemoradiotherapy (P=0.183).
Use of chemoradiotherapy for adjuvant treatment of salivary gland malignancies was well-tolerated, but no improvement in survival was seen with the use of chemoradiotherapy in both the overall study population and a subset with high-risk features. Caution should be used when using this modality until randomized evidence becomes available.
辅助性放射治疗（RT）适用于涎腺恶性肿瘤切除术后有复发风险因素的患者。我们分析了接受辅助性RT联合或不联合同步化疗的患者，以确定预后和治疗因素的影响。
对128例行手术切除后接受调强放疗的患者进行回顾性分析。共有31例（24.2%）患者接受同步放化疗。采用Kaplan-Meier法估计无进展生存期（PFS）、局部区域控制率、远处控制率和总生存率。进行多变量Cox回归分析以评估单变量分析中有显著意义的因素。
PFS、局部区域控制率、无远处转移生存率和总生存率的5年率分别为61.2%、85.8%、76.5%和73.7%。单变量分析中PFS降低的预测因素包括年龄、肿瘤分期、淋巴结分期、手术切缘阳性、组织学类型、高级别、神经周围侵犯、脉管间隙侵犯、结外扩展和同步放化疗的使用。多变量分析中，T分期升高、手术切缘阳性和结外扩展的存在是PFS降低的预测因素。急性毒性发生率为1级30.3%、2级51.5%、3级11.4%和4级0.8%。单纯放疗与同步放化疗相比，3级或更高急性毒性发生率无差异（P = 0.183）。
同步放化疗用于涎腺恶性肿瘤的辅助治疗耐受性良好，但在整个研究人群和具有高危特征的亚组中，同步放化疗均未改善生存率。在有随机证据可用之前，使用这种治疗方式时应谨慎。
