Doyen J, Lam Cham Kee D, Krebs L, Guigay J, Dassonville O, Peyrade F, Poissonnet G, Saâda-Bouzid E, Sudaka A, Bozec A, Bénézery K
Pôle de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France; Université Côte d'Azur, Nice, France.
Pôle de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France; Université Côte d'Azur, Nice, France.
Cancer Radiother. 2017 Oct;21(6-7):521-526. doi: 10.1016/j.canrad.2017.07.023. Epub 2017 Aug 18.
Locoregional relapse in previously irradiated region for head and neck tumours is associated with a bad locoregional and distant prognosis. Reirradiation might be exclusive, or feasible in addition with surgery and/or chemotherapy, according to histopronostic factors. Data show that reirradiation is feasible with some severe toxicity due to the bad prognosis of this situation. Hyperfractionnated regimen with split course or normofractionnated regimen without split course are possible with similar efficacy. If tumour size is small, stereotactic ablative radiotherapy may be considered, and if the treatment centre has proton therapy, it could be proposed because of better organs at risk sparing. There is no standard regarding reirradiation schedules and several trials have to be done in order to determine the best technique. Nevertheless, it is agreed that a total dose of 60Gy (2Gy per fraction) is needed. Other trials testing the association with new systemic agents have to be performed, among them agents targeting the PD1/PD-L1 axis.
头颈部肿瘤既往照射区域的局部区域复发与不良的局部区域及远处预后相关。根据组织预后因素，再程放疗可能是唯一的选择，或者与手术和/或化疗联合应用也是可行的。数据表明，鉴于这种情况预后不良，再程放疗虽伴有一些严重毒性但仍是可行的。采用分割疗程的超分割方案或不采用分割疗程的常规分割方案都有可能，且疗效相似。如果肿瘤体积较小，可以考虑立体定向消融放疗，并且如果治疗中心有质子治疗设备，由于其对危及器官的保护更好，也可采用。关于再程放疗方案尚无标准，需要开展多项试验以确定最佳技术。然而，人们一致认为需要60Gy（每次分割2Gy）的总剂量。还必须开展其他试验来测试与新的全身治疗药物联合应用的效果，其中包括靶向PD1/PD-L1轴的药物。
