Hôpital Neuchâtelois de La Chaux-de-Fonds, La Chaux-de-Fonds, Switzerland.
Centre Hospitalier du Valais Romand, Sion, Switzerland.
Oncology. 2018;95(2):61-68. doi: 10.1159/000489217. Epub 2018 Jun 12.
To assess the feasibility and efficacy of intensity-modulated radiation implemented with helical tomotherapy image-guided with daily megavoltage computed tomography for head and neck cancer.
Between May 2010 and May 2013, 72 patients were treated with curative intent. The median age was 64 years, with 57% undergoing definitive and 43% postoperative radiotherapy. Primary tumour sites were oral cavity (21%), oropharynx (26%), hypopharynx (20%), larynx (22%), and others (11%). Staging included 4% stage I, 15% II, 26% III, 48% IVa, and 7% IVb. Radiotherapy was combined with chemotherapy in 64%. Primary endpoint was locoregional control, and secondary endpoints survival and toxicity.
Median follow-up was 20 months, with 11 locoregional recurrences. Three-year disease-free survival was 58% and overall survival 57%. In the multivariate analysis, age under 64 years, no extracapsular extension, postoperative radiotherapy, induction chemotherapy, and non-oral cavity tumour were significant favourable prognostic factors for disease-free-survival. The overall incidence of acute grade ≥3 toxicities were mucositis 32%, pain 11%, xerostomia 7%, dysphagia 53%, radiodermatitis 44%, and osteonecrosis 1%. Late grade ≥3 toxicities were fibrosis 6%, dysphagia 21%, fistula 1%, and skin necrosis 1%.
Intensity-modulated radiation with helical tomotherapy achieved respectable locoregional control and overall survival, with acceptable toxicity, in head and neck cancer patients.
评估头颈部癌调强放射治疗，结合每日兆伏 CT 图像引导螺旋断层放疗的可行性和疗效。
2010 年 5 月至 2013 年 5 月，72 例患者接受了根治性治疗。中位年龄为 64 岁，57%的患者接受了根治性放疗，43%的患者接受了术后放疗。原发肿瘤部位为口腔（21%）、口咽（26%）、下咽（20%）、喉（22%）和其他部位（11%）。分期包括 4%的 I 期、15%的 II 期、26%的 III 期、48%的 IVa 期和 7%的 IVb 期。64%的患者接受了放化疗联合治疗。主要终点为局部区域控制，次要终点为生存和毒性。
中位随访时间为 20 个月，11 例出现局部区域复发。3 年无病生存率为 58%，总生存率为 57%。多因素分析显示，年龄<64 岁、无包膜外侵犯、术后放疗、诱导化疗和非口腔肿瘤是无病生存的显著有利预后因素。急性≥3 级毒性的总发生率为黏膜炎 32%、疼痛 11%、口干 7%、吞咽困难 53%、放射性皮炎 44%和骨坏死 1%。晚期≥3 级毒性的总发生率为纤维化 6%、吞咽困难 21%、瘘管 1%和皮肤坏死 1%。
头颈部癌调强放射治疗结合螺旋断层放疗，实现了令人满意的局部区域控制和总体生存率，同时具有可接受的毒性。
