头颈部鳞状细胞癌标准联合治疗模式下的术后放疗剂量需求：两个队列中显著手术和放疗参数的分析

Postoperative radiotherapy dose requirement in standard combined-modality practice for head and neck squamous cell carcinoma: Analysis of salient surgical and radiotherapy parameters in 2 cohorts.

作者信息

Mohanti Bidhu K, Thakar Alok, Kaur Jaspreet, Bahadur Sudhir, Malik Monica, Gandhi Ajeet K, Bhasker Suman, Sharma Atul

机构信息

Department of Radiotherapy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Department of Ear, Nose, and Throat, and Head Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

出版信息

Head Neck. 2017 Sep;39(9):1788-1796. doi: 10.1002/hed.24836. Epub 2017 Jun 6.

DOI:10.1002/hed.24836

PMID:28586138

Abstract

BACKGROUND

This study compared 2 sequential cohorts to identify the postoperative radiotherapy (PORT) dose requirement for head and neck squamous cell carcinoma (HNSCC).

METHODS

Two distinct PORT dose regimens were prescribed over 11 years; group 1 received 56 Gy or less, and group 2 received 60 Gy or more. The 2D and 3D techniques were used.

RESULTS

Two sequential cohorts consisted of 478 patients, with mean and median follow-up for group 1 and 2 as: 37.0 versus 28.5 months and 13.8 versus 13.1 months, respectively. Grades 3-4 mucosal toxicities (11.4% vs 28.3%), hospitalization (3.2% vs 17.4%), and nasogastric feeding (11.9% vs 29.7%) were higher in group 2. The 2-year disease-free survival (DFS) was higher with PORT >60 Gy for the following factors: age ≤ 50 years (P = .041); ≥ 4 positive nodes (P = .029); and overall treatment time (OTT) ≥ 100 days (P = .042).

CONCLUSION

Except for the benefit of doses >60 Gy for limited parameters, a lower PORT dose did not compromise the results and can potentially reduce the morbidities and healthcare costs.

摘要

背景

本研究比较了两个连续队列，以确定头颈部鳞状细胞癌（HNSCC）术后放疗（PORT）的剂量需求。

方法

在11年期间规定了两种不同的PORT剂量方案；第1组接受56 Gy或更低剂量，第2组接受60 Gy或更高剂量。采用了二维和三维技术。

结果

两个连续队列包括478例患者，第1组和第2组的平均和中位随访时间分别为：37.0个月对28.5个月，13.8个月对13.1个月。第2组的3-4级黏膜毒性（11.4%对28.3%）、住院率（3.2%对17.4%）和鼻饲率（11.9%对29.7%）更高。对于以下因素，PORT>60 Gy时2年无病生存率（DFS）更高：年龄≤50岁（P = 0.041）；≥4个阳性淋巴结（P = 0.029）；以及总治疗时间（OTT）≥100天（P = 0.042）。