术后放疗治疗下颌下腺癌时的淋巴结失败模式和选择性淋巴结照射的作用 - 一项多中心经验。
Nodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy - a multicenter experience.
机构信息
Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.
Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.
出版信息
Radiat Oncol. 2018 Sep 21;13(1):184. doi: 10.1186/s13014-018-1130-y.
BACKGROUND
The patterns of nodal relapse in submandibular gland carcinoma (SMGC) patients treated with postoperative radiotherapy (PORT) remain unclear. This study aims to investigate the nodal failure patterns and the utility of elective nodal irradiation (ENI) in SMGC patients undergoing PORT.
METHODS
We retrospectively enrolled 65 SMGC patients who underwent PORT between 2000 and 2014. The nodal failure sites in relation to irradiation fields and pathological parameters were analyzed. ENI regions were categorized into three bilateral echelons (first, levels I-II; second, level III; and third, levels IV-V). Extended ENI was defined as coverage of at least the immediately adjacent uninvolved echelons bilaterally; otherwise, limited ENI was administered.
RESULTS
Thirty patients (46%) were stage III-IV, and 18 (28%) were pN+. Neck irradiation included limited (72%) and extended ENI (28%). With a median follow-up of 79 months, 11 patients (17%) developed nodal failures (ipsilateral, N = 6; contralateral, N = 7), 7 (64%) of whom relapsed in the adjacent uninvolved echelons. We identified pN+ (P = 0.030), extranodal extension (ENE, P = 0.002), pT3-4 (P = 0.021), and lymphovascular invasion (LVI, P = 0.004) as significant predictors of contralateral neck recurrence. Extended ENI significantly improved regional control (RC) in patients with pN+ (P = 0.003), ENE (P = 0.022), pT3-4 (P = 0.044), and LVI (P = 0.014), and improved disease-free survival (DFS) in patients with pN+ (P = 0.034). For patients with ≥2 coincident adverse factors, extended ENI significantly increased RC (P < 0.001), distant metastasis-free survival (P = 0.019), and DFS (P = 0.007); conversely, no nodal recurrence was observed in patients without these adverse factors, even when only the involved echelon was irradiated.
CONCLUSIONS
Nodal failure is not uncommon in SMGC patients treated with PORT if pN+, ENE, pT3-4, and LVI are present. Extended ENI should be considered, particularly in patients with multiple pathological adverse factors.
背景
接受术后放疗（PORT）的下颌下腺癌（SMGC）患者的淋巴结复发模式仍不清楚。本研究旨在探讨 SMGC 患者 PORT 中淋巴结失败的模式和选择性淋巴结照射（ENI）的作用。
方法
我们回顾性纳入了 2000 年至 2014 年间接受 PORT 的 65 例 SMGC 患者。分析了与照射野和病理参数相关的淋巴结失败部位。ENI 区域分为三个双侧梯队（第一梯队，I-II 级；第二梯队，III 级；第三梯队，IV-V 级）。扩展 ENI 定义为双侧至少覆盖相邻未受累梯队；否则，给予局限性 ENI。
结果
30 例（46%）为 III-IV 期，18 例（28%）为 pN+。颈部照射包括局限性（72%）和扩展 ENI（28%）。中位随访 79 个月后，11 例（17%）发生淋巴结失败（同侧，N=6；对侧，N=7），7 例（64%）在相邻未受累梯队复发。我们发现 pN+（P=0.030）、结外扩展（ENE，P=0.002）、pT3-4（P=0.021）和血管淋巴管侵犯（LVI，P=0.004）是对侧颈部复发的显著预测因素。在 pN+（P=0.003）、ENE（P=0.022）、pT3-4（P=0.044）和 LVI（P=0.014）患者中，扩展 ENI 显著改善了区域控制（RC），在 pN+（P=0.034）患者中改善了无病生存（DFS）。对于存在≥2 个合并不良因素的患者，扩展 ENI 显著增加了 RC（P<0.001）、无远处转移生存（P=0.019）和 DFS（P=0.007）；相反，在没有这些不良因素的患者中，即使仅照射受累梯队，也没有观察到淋巴结复发。
结论
如果存在 pN+、ENE、pT3-4 和 LVI，接受 PORT 的 SMGC 患者淋巴结复发并不罕见。应考虑扩展 ENI，特别是在存在多个病理不良因素的患者中。
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