不同术后放疗策略治疗头颈部鳞状细胞癌的临床结果比较。

Comparisons of the clinical outcomes of different postoperative radiation strategies for treatment of head and neck squamous cell carcinoma.

作者信息

Makita Chiyoko, Kodaira Takeshi, Daimon Takashi, Tachibana Hiroyuki, Tomita Natsuo, Koide Yutaro, Koide Yusuke, Fukuda Yujiro, Nishikawa Daisuke, Suzuki Hidenori, Hanai Nobuhiro, Hasegawa Yasuhisa

机构信息

Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya.

Department of Biostatistics, Hyogo College of Medicine, Hyogo.

出版信息

Jpn J Clin Oncol. 2017 Dec 1;47(12):1141-1150. doi: 10.1093/jjco/hyx137.

DOI:10.1093/jjco/hyx137

PMID:29036621

Abstract

PURPOSE

We previously reported unfavorable locoregional control with limited field postoperative radiotherapy for head and neck squamous cell carcinoma patients and thus revised the strategy to cover the whole neck. Head and neck squamous cell carcinoma Patients' outcomes were retrospectively analyzed to compare the efficacy of two treatments.

MATERIAL AND METHODS

Before 2010, the clinical target volume covered the tumor bed and/or involved the neck region. Since 2011, whole-neck irradiation was planned. Univariate analysis, multivariate analysis, and propensity score matching were performed. The study included 275 patients: 186 received limited field postoperative radiotherapy and 89 received whole-neck postoperative radiotherapy. The median follow-up time for the entire cohort was 40.8 months.

RESULTS

In univariate analysis, the radiation strategy had no significant effect on overall survival and progression-free survival. In multivariate analysis, whole-neck postoperative radiotherapy was a favorable factor for overall survival, progression-free survival, and locoregional control. Propensity score matching resulted in a cohort comprising 118 well-matched patients evenly divided between the limited field postoperative radiotherapy and whole-neck postoperative radiotherapy groups. Whole-neck postoperative radiotherapy group achieved a significantly better 2-year overall survival (56.4% vs. 78.1%; P = 0.003), 2-year progression-free survival (34.7% vs. 59.8%; P = 0.009), and 2-year locoregional control (54.4% vs. 83.2%; P < 0.001). The limited field postoperative radiotherapy group developed significantly more locoregional recurrences both in-field (35.2% vs. 15.1%, P = 0.003) and out-of-field (25.0% vs. 0%, P < 0.001) in the matched-pair cohort.

CONCLUSION

Whole-neck postoperative radiotherapy is a more appropriate choice than limited field postoperative radiotherapy to improve overall survival, progression-free survival and locoregional control.

摘要

目的

我们之前报道过，对头颈部鳞状细胞癌患者采用有限野术后放疗，局部区域控制效果不佳，因此修订了治疗策略，将全颈部纳入放疗范围。对头颈部鳞状细胞癌患者的治疗结果进行回顾性分析，以比较两种治疗方法的疗效。

材料与方法

2010年之前，临床靶区包括肿瘤床和/或累及颈部区域。自2011年起，计划进行全颈部照射。进行了单因素分析、多因素分析和倾向评分匹配。该研究纳入了275例患者：186例接受有限野术后放疗，89例接受全颈部术后放疗。整个队列的中位随访时间为40.8个月。

结果

在单因素分析中，放疗策略对总生存期和无进展生存期无显著影响。在多因素分析中，全颈部术后放疗是总生存期、无进展生存期和局部区域控制的有利因素。倾向评分匹配后形成了一个队列，其中包括118例匹配良好的患者，有限野术后放疗组和全颈部术后放疗组各占一半。全颈部术后放疗组的2年总生存率（56.4%对78.1%；P = 0.003）、2年无进展生存率（34.7%对59.8%；P = 0.009）和2年局部区域控制率（54.4%对83.2%；P < 0.001）均显著更好。在匹配对队列中，有限野术后放疗组的野内（35.2%对15.1%，P = 0.003）和野外（25.0%对0%，P < 0.001）局部区域复发明显更多。