根治性放疗治疗头颈部癌症患者的监测影像的作用。
Usefulness of surveillance imaging in patients with head and neck cancer who are treated with definitive radiotherapy.
机构信息
Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
The University of Texas Health Science Center, San Antonio, Texas.
出版信息
Cancer. 2019 Jun 1;125(11):1823-1829. doi: 10.1002/cncr.31983. Epub 2019 Feb 12.
BACKGROUND
The current study was performed to assess the efficacy of surveillance imaging in patients with head and neck cancer (HNC) who are treated definitively with radiotherapy.
METHODS
Eligible patients included those with a demonstrable disease-free interval (≥1 follow-up imaging procedure without evidence of disease and a subsequent visit/imaging procedure) who underwent treatment of HNC from 2000 through 2010.
RESULTS
A total of 1508 patients were included. The median overall survival was 99 months, with a median imaging follow-up period of 59 months. Of the 1508 patients, 190 patients (12.6%) experienced disease recurrence (107 patients had locoregional and 83 had distant disease recurrence). A total of 119 patients (62.6%) in the group with disease recurrence were symptomatic and/or had an adverse clinical finding associated with the recurrence. Approximately 80% of patients with locoregional disease recurrences presented with a clinical finding, whereas 60% of distant disease recurrences were detected by imaging in asymptomatic patients. Despite the earlier detection of disease recurrence via imaging, those patients in the group of patients with clinically detected disease recurrence were significantly more likely to undergo salvage therapy compared with those whose recurrence was detected on imaging (odds ratio, 0.35). There was no difference in overall survival noted between those patients with disease recurrences that were detected clinically or with imaging alone. Approximately 70% of disease recurrences occurred within the first 2 years. In those patients who developed disease recurrence after 2 years, the median time to recurrence was 51 months. After 2 years, the average number of imaging procedures per patient for the detection of a salvageable recurrence for the imaging-detected group was 1539.
CONCLUSIONS
Surveillance imaging in asymptomatic patients with HNC who are treated definitively with radiotherapy without clinically suspicious findings beyond 2 years has a low yield and a high cost. Physicians ordering these studies must use judicious consideration and discretion.
背景
本研究旨在评估对接受根治性放疗的头颈部癌症（HNC）患者进行监测成像的疗效。
方法
符合条件的患者包括在 2000 年至 2010 年期间接受 HNC 治疗且具有无疾病间隔期（≥1 次无疾病随访影像学检查和随后的就诊/影像学检查）的患者。
结果
共纳入 1508 例患者。中位总生存期为 99 个月，中位影像学随访时间为 59 个月。在 1508 例患者中，190 例（12.6%）发生疾病复发（107 例局部区域复发，83 例远处复发）。在疾病复发组中，有 119 例（62.6%）患者出现症状和/或有与复发相关的不良临床发现。大约 80%的局部区域疾病复发患者出现了临床发现，而 60%的无症状远处疾病复发患者是通过影像学检测到的。尽管通过影像学更早地发现了疾病复发，但与通过影像学检测到疾病复发的患者相比，在通过临床检测到疾病复发的患者中，更有可能进行挽救性治疗（比值比，0.35）。在影像学或临床单独检测到疾病复发的患者之间，总生存期无差异。约 70%的疾病复发发生在最初的 2 年内。在 2 年后发生疾病复发的患者中，复发的中位时间为 51 个月。2 年后，对于影像学检测到的有挽救机会的复发患者，每位患者的平均影像学检查次数为 1539 次。
结论
在接受根治性放疗且无临床可疑发现超过 2 年的无症状 HNC 患者中，进行监测成像的效果不佳，成本高。开具这些检查的医生必须谨慎考虑和判断。
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