Yamazaki Hideya, Demizu Yusuke, Okimoto Tomoaki, Ogita Mikio, Himei Kengo, Nakamura Satoaki, Suzuki Gen, Yoshida Ken, Kotsuma Tadayuki, Yoshioka Yasuo, Oh Ryoongjin
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, 602-8566, Kamigyo-ku, Kyoto, Japan.
CyberKnife Center, Soseikai General Hospital, 126 Kami-Misu, Shimotoba Fushimi-ku, Kyoto, Japan.
Strahlenther Onkol. 2017 Jul;193(7):525-533. doi: 10.1007/s00066-017-1129-6. Epub 2017 Apr 19.
To examine the outcomes of reirradiation for recurrent head and neck cancers using different modalities.
This retrospective study included 26 patients who received charged particle radiotherapy (CP) and 150 who received photon radiotherapy (117 CyberKnife radiotherapy [CK] and 36 intensity-modulated radiotherapy [IMRT]). Inverse probability of treatment weighting (IPTW) involving propensity scores was used to reduce background selection bias.
Higher prescribed doses were used in CP than photon radiotherapy. The 1‑year overall survival (OS) rates were 67.9% for CP and 54.1% for photon radiotherapy (p = 0.15; 55% for CK and 51% for IMRT). In multivariate Cox regression, the significant prognostic factors for better survival were nasopharyngeal cancer, higher prescribed dose, and lower tumor volume. IPTW showed a statistically significant difference between CP and photon radiotherapy (p = 0.04). The local control rates for patients treated with CP and photon radiotherapy at 1 year were 66.9% (range 46.3-87.5%) and 67.1% (range 58.3-75.9%), respectively. A total of 48 patients (27%) experienced toxicity grade ≥3 (24% in the photon radiotherapy group and 46% in the CP group), including 17 patients with grade 5 toxicity. Multivariate analysis revealed that younger age and a larger planning target volume (PTV) were significant risk factors for grade 3 or worse toxicity.
CP provided superior survival outcome compared to photon radiotherapy. Tumor volume, primary site (nasopharyngeal), and prescribed dose were identified as survival factors. Younger patients with a larger PTV experienced toxicity grade ≥3.
使用不同方式检查复发性头颈癌再程放疗的结果。
这项回顾性研究纳入了26例接受带电粒子放疗（CP）的患者和150例接受光子放疗的患者（117例接受射波刀放疗[CK]，36例接受调强放疗[IMRT]）。采用涉及倾向评分的治疗权重逆概率（IPTW）来减少背景选择偏倚。
CP组的处方剂量高于光子放疗组。CP组1年总生存率（OS）为67.9%，光子放疗组为54.1%（p = 0.15；CK组为55%，IMRT组为51%）。在多因素Cox回归分析中，生存情况较好的显著预后因素为鼻咽癌、较高的处方剂量和较小的肿瘤体积。IPTW显示CP组和光子放疗组之间存在统计学显著差异（p = 0.04）。接受CP和光子放疗的患者1年局部控制率分别为66.9%（范围46.3 - 87.5%）和67.1%（范围58.3 - 75.9%）。共有48例患者（27%）出现≥3级毒性反应（光子放疗组为24%，CP组为46%），其中17例患者出现5级毒性反应。多因素分析显示，年龄较小和计划靶体积（PTV）较大是3级或更严重毒性反应的显著危险因素。
与光子放疗相比，CP放疗的生存结果更佳。肿瘤体积、原发部位（鼻咽癌）和处方剂量被确定为生存因素。PTV较大的年轻患者出现≥3级毒性反应。
