三维适形放射治疗与对侧浅叶腮腺保留调强放射治疗口咽癌和下咽癌后口干发生率的比较。
Comparison of xerostomia incidence after three-dimensional conformal radiation therapy and contralateral superficial lobe parotid-sparing intensity-modulated radiotherapy for oropharyngeal and hypopharyngeal cancer.
作者信息
Kawamoto Terufumi, Nihei Keiji, Nakajima Yujiro, Kito Satoshi, Sasai Keisuke, Karasawa Katsuyuki
机构信息
Division of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan; Graduate School of Medicine Department of Radiology, Juntendo University, Japan.
Division of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan.
出版信息
Auris Nasus Larynx. 2018 Oct;45(5):1073-1079. doi: 10.1016/j.anl.2018.01.010. Epub 2018 Feb 1.
OBJECTIVE
In the treatment of head-neck cancer, parotid-sparing intensity-modulated radiotherapy (IMRT) could reduce the incidence of xerostomia. When the parotid glands cannot be sufficiently spared because of the widespread tumor, contralateral superficial lobe parotid-sparing (CSLPS)-IMRT could be used to reduce marginal recurrence, however the success of this approach remains to be determined. The primary purpose of this study was to compare the incidence of xerostomia between three-dimensional conformal radiotherapy (3D-CRT) and CSLPS-IMRT for oropharyngeal and hypopharyngeal cancer. In a second aim, we also compared the clinical efficacy of 3D-CRT and CSLPS-IMRT.
METHODS
We retrospectively reviewed the medical records of locally advanced oropharyngeal and hypopharyngeal cancer patients who were treated with definitive concurrent chemoradiotherapy between June 2007 and April 2014. We estimated the average mean dose delivered to the parotid glands, the incidence of xerostomia≥Grade 2, patterns of failure, and survival outcomes.
RESULTS
Seventeen patients received 3D-CRT and 21 received CSLPS-IMRT. The average mean dose delivered to the superficial lobe of the contralateral parotid gland was 45.3Gy and 26.6Gy (p<0.001), and the incidence of xerostomia≥Grade 2 following treatment was 75% and 26% at 12 months (p=0.012) and 67% and 18% at 24 months (p=0.018) in the 3D-CRT and CSLPS-IMRT groups, respectively. Patterns of failure did not differ between the two groups. The 2-year progression-free survival was 59% and 62% (p=0.73), and the 2-year overall survival rate was 71% and 71% in the 3D-CRT and CSLPS-IMRT groups, respectively (p=0.76).
CONCLUSION
Incidence of xerostomia was significantly lower in patients receiving CSLPS-IMRT compared with 3D-CRT, while clinical efficacy did not differ between two treatment strategies.
目的
在头颈癌治疗中，保留腮腺的调强放射治疗（IMRT）可降低口干症的发生率。当由于肿瘤广泛而无法充分保留腮腺时，可采用对侧腮腺浅叶保留（CSLPS）-IMRT来减少边缘复发，然而这种方法的成功率仍有待确定。本研究的主要目的是比较三维适形放疗（3D-CRT）与CSLPS-IMRT治疗口咽癌和下咽癌时口干症的发生率。其次，我们还比较了3D-CRT与CSLPS-IMRT的临床疗效。
方法
我们回顾性分析了2007年6月至2014年4月期间接受确定性同步放化疗的局部晚期口咽癌和下咽癌患者的病历。我们评估了腮腺接受的平均剂量、≥2级口干症的发生率、失败模式和生存结果。
结果
17例患者接受3D-CRT，21例接受CSLPS-IMRT。3D-CRT组和CSLPS-IMRT组对侧腮腺浅叶接受的平均剂量分别为45.3Gy和26.6Gy（p<0.001），治疗后12个月时≥2级口干症的发生率分别为75%和26%（p=0.012），24个月时分别为67%和18%（p=0.018）。两组的失败模式无差异。3D-CRT组和CSLPS-IMRT组的2年无进展生存率分别为59%和62%（p=0.73），2年总生存率分别为71%和71%（p=0.76）。
结论
与3D-CRT相比，接受CSLPS-IMRT的患者口干症发生率显著降低，而两种治疗策略的临床疗效无差异。
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