Korpics Mark C, Turchan W Tyler, Rooney Michael K, Koshy Matthew, Spiotto Michael T
Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL 60637, USA.
Department of Radiation Oncology, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, USA.
Cancers (Basel). 2019 Dec 12;11(12):1996. doi: 10.3390/cancers11121996.
Early stage glottic cancer has traditionally been treated with 3D conformal radiotherapy (3DCRT). However, intensity-modulated radiotherapy (IMRT) has been recently adopted as an alternative to decrease toxicity. Here, we compared the usage and outcomes of IMRT and 3DCRT for patients with early stage squamous cell carcinoma (SCC) of the glottic larynx. Using the National Cancer Database, we identified patients with Stage I-II SCC of the glottis who received 55-75 Gy using IMRT ( = 1623) or 3DCRT ( = 2696). Median follow up was 42 months with a 5-year overall survival (OS) of 72%. Using a nominal logistic regression, race, ethnicity, year of diagnosis and fraction size were associated with the receipt of IMRT ( < 0.05). Using Kaplan-Meier methods and Cox proportional hazards models as well as a propensity matched cohort, there was no difference in OS for patients who received IMRT versus 3DCRT (hazard ratio (HR), 1.08; 95% confidence interval (95% CI), 0.93-1.26; = 0.302). However, there was a survival benefit for patients receiving slight hypofractionation as compared to conventional fractionation (HR, 0.78; 95% CI, 0.69-0.92; = 0.003). IMRT was associated with similar survival as 3DCRT, supporting the implementation of this potentially less toxic modality without compromising survival.
早期声门癌传统上采用三维适形放疗（3DCRT）进行治疗。然而，调强放疗（IMRT）最近已被用作一种替代方法以降低毒性。在此，我们比较了IMRT和3DCRT用于早期声门鳞状细胞癌（SCC）患者的使用情况和治疗结果。利用国家癌症数据库，我们确定了接受IMRT（n = 1623）或3DCRT（n = 2696）且剂量为55 - 75 Gy的I - II期声门SCC患者。中位随访时间为42个月，5年总生存率（OS）为72%。使用名义逻辑回归分析，种族、民族、诊断年份和分次剂量与接受IMRT相关（P < 0.05）。使用Kaplan - Meier方法、Cox比例风险模型以及倾向匹配队列分析，接受IMRT与3DCRT的患者在OS方面没有差异（风险比（HR），1.08；95%置信区间（95%CI），0.93 - 1.26；P = 0.302）。然而，与传统分割放疗相比，接受轻度超分割放疗的患者有生存获益（HR，0.78；95%CI，0.69 - 0.92；P = 0.003）。IMRT与3DCRT的生存情况相似，这支持了在不影响生存的情况下实施这种潜在毒性较小的放疗方式。
