de Veij Mestdagh Pieter D, van Werkhoven Eric, Navran Arash, de Boer Jan Paul, Schreuder Willem H, Vogel Wouter V, Al-Mamgani Abrahim
Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
Clin Transl Radiat Oncol. 2019 Apr 19;17:7-13. doi: 10.1016/j.ctro.2019.04.015. eCollection 2019 Jul.
The vast majority of patients with head and neck squamous cell carcinoma (HNSCC) routinely undergo elective nodal irradiation (ENI) to both sides of the neck. Little is known about the extent to which bilateral ENI prevents regional failure (RF) and contralateral RF (cRF) in particular, while such knowledge is necessary to evaluate the results of more selective approaches like unilateral ENI. We investigated the rate and pattern of RF after bilateral ENI, the rate of cRF in the electively irradiated contralateral neck, and tried to identify risk factors for development of cRF.
Retrospective cohort study of a consecutive series of 605 patients with T1-4N0-3 HNSCC treated between 2008 and 2017 with primary (chemo)radiation and bilateral ENI.
Median follow-up was 43 months (range 1.4-126). Three-year cumulative incidence of RF was 12.7%. Three-year cumulative incidences of ipsilateral RF (iRF) and cRF were 10.6% and 2.8%, respectively. All cRF occurred within the electively treated volume. Salvage treatment was possible in 65% and 59% of patients with iRF and cRF, respectively (p = 0.746). The 3-year overall survival rates after RF in patients with iRF and cRF were 27.4% and 41.2%, respectively (p = 0.713). Three-year cancer-specific survival rates were 31.6% and 48.1%, respectively (p = 0.634). In multivariate analysis, no significant predictive factors were identified for cRF after bilateral ENI.
Contralateral regional failure is rare, but still occurs in 2.8% of patients treated with bilateral ENI. The possibilities for salvage treatment, the rates of overall survival and cancer-specific survival were comparable to patients with iRF.
绝大多数头颈部鳞状细胞癌（HNSCC）患者通常会对双侧颈部进行选择性淋巴结照射（ENI）。对于双侧ENI预防区域复发（RF）尤其是对侧区域复发（cRF）的程度了解甚少，而这些信息对于评估像单侧ENI这样更具选择性的治疗方法的效果是必要的。我们研究了双侧ENI后RF的发生率和模式、选择性照射对侧颈部的cRF发生率，并试图确定cRF发生的危险因素。
对2008年至2017年间接受原发（化疗）放疗及双侧ENI治疗的605例T1-4N0-3 HNSCC患者进行回顾性队列研究。
中位随访时间为43个月（范围1.4 - 126个月）。三年累积RF发生率为12.7%。同侧RF（iRF）和cRF的三年累积发生率分别为10.6%和2.8%。所有cRF均发生在选择性治疗区域内。iRF和cRF患者分别有65%和59%可行挽救性治疗（p = 0.746）。iRF和cRF患者RF后的三年总生存率分别为27.4%和41.2%（p = 0.713）。三年癌症特异性生存率分别为31.6%和48.1%（p = 0.634）。多因素分析未发现双侧ENI后cRF的显著预测因素。
对侧区域复发罕见，但在接受双侧ENI治疗的患者中仍有2.8%发生。挽救性治疗的可能性、总生存率和癌症特异性生存率与iRF患者相当。
