Department of Radiotherapy, European Institute of Oncology, Milan, Italy.
Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdańsk, Poland.
Med Oncol. 2018 Mar 28;35(5):59. doi: 10.1007/s12032-018-1118-3.
Intensity-modulated radiotherapy (IMRT) is considered the preferred option in squamous cell canal cancer (SCAC), delivering high doses to tumor volumes while minimizing dose to surrounding normal tissues. IMRT has steep dose gradients, but the technique is more demanding as deep understanding of target structures is required. To evaluate genital marginal failure in a cohort of patients with non-metastatic SCAC treated either with IMRT or 3DCRT and concurrent chemotherapy, 117 patients with SCAC were evaluated: 64 and 53 patients were treated with IMRT and 3DCRT techniques, respectively. All patients underwent clinical and radiological examination during their follow-up. Tumor response was evaluated with response evaluation criteria in solid tumors v1.1 guideline on regular basis. All patients' data were analyzed, and patients with marginal failure were identified. Concomitant chemotherapy was administered in 97 and 77.4% of patients in the IMRT and 3DCRT groups, respectively. In the IMRT group, the median follow-up was 25 months (range 6-78). Progressive disease was registered in 15.6% of patients; infield recurrence, distant recurrence and both infield recurrence and distant recurrence were identified in 5, 4 and 1 patient, respectively. Two out of 64 patients (3.1%) had marginal failures, localized at vagina/recto-vaginal septum and left perineal region. In the 3DCRT group, the median follow-up was 71.3 months (range 6-194 months). Two out of 53 patients (3.8%) had marginal failures, localized at recto-vaginal septum and perigenital structures. The rate of marginal failures was comparable in IMRT and 3DCRT groups (χ test p = 0.85). In this series, the use of IMRT for the treatment of SCAC did not increase the rate of marginal failures offering improved dose conformity to the target. Dose constraints should be applied with caution-particularly in females with involvement of the vagina or the vaginal septum.
调强放疗（IMRT）被认为是治疗鳞状细胞咽癌（SCAC）的首选方法，它可以在向肿瘤体积提供高剂量的同时，将剂量最小化至周围正常组织。IMRT 具有陡峭的剂量梯度，但由于需要对目标结构有深入的了解，因此该技术要求更高。为了评估非转移性 SCAC 患者在接受调强放疗（IMRT）或三维适形放疗（3DCRT）联合化疗后的生殖边缘失败率，评估了 117 例 SCAC 患者：64 例和 53 例患者分别接受了 IMRT 和 3DCRT 治疗。所有患者在随访期间均接受了临床和影像学检查。根据实体瘤反应评价标准 1.1 版，定期评价肿瘤反应。分析了所有患者的数据，并确定了边缘失败的患者。分别有 97%和 77.4%的 IMRT 和 3DCRT 组患者接受了同步化疗。在 IMRT 组中，中位随访时间为 25 个月（范围 6-78 个月）。15.6%的患者发生进展性疾病；5 例、4 例和 1 例患者分别发生了野内复发、远处复发和野内及远处复发。64 例患者中有 2 例（3.1%）出现了边缘失败，局限于阴道/直肠阴道隔和左侧会阴区。在 3DCRT 组中，中位随访时间为 71.3 个月（范围 6-194 个月）。53 例患者中有 2 例（3.8%）出现了边缘失败，局限于直肠阴道隔和会阴部结构。IMRT 和 3DCRT 组的边缘失败率无差异（X²检验，p=0.85）。在本系列研究中，IMRT 用于治疗 SCAC 并未增加边缘失败率，同时为靶区提供了更好的剂量适形性。剂量限制应谨慎应用-特别是对于阴道或阴道隔受累的女性。
