Haderlein Marlen, Speer Stefan, Ott Oliver, Lettmaier Sebastian, Hecht Markus, Semrau Sabine, Frey Benjamin, Scherl Claudia, Iro Heinrich, Kesting Marco, Fietkau Rainer
Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
Department of Otorhinolaryngology, Universitätsklinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
Cancers (Basel). 2020 Feb 26;12(3):538. doi: 10.3390/cancers12030538.
Evaluating radiotherapy treatment plans of the prospective DIREKHT trial (ClinicalTrials.gov, NCT02528955) investigating de-intensification of radiotherapy in patients with head and neck cancer.
The first 30 patients from the DIREKHT trial of the leading study centre were included in this analysis. Standard treatment plans and study treatment plans derived from the protocol were calculated for each patient. Sizes of planning target volumes (PTVs) and mean doses to organs at risk were compared using the Student's t-test with paired samples.
Mean PTV3 including primary tumor region and ipsilateral elective neck up to a dose of 50 Gy in the study treatment plans was 662 mL (+/- 165 mL standard deviation (SD)) and therefore significantly smaller than those of the standard treatment plans (1166 mL (+/- 266 mL SD). In the medial and inferior constrictor muscles, cricopharyngeal muscle, glottic and supraglottic laryngeal areas, arytenoid cartilages, contralateral major salivary glands highly significant dose reductions ( < 0.0001) of more than 10 Gy were achieved in study treatment plan compared to standard treatment plan.
De-intensification of radiotherapy led to smaller planning target volumes and clinical relevant dose reductions in the swallowing apparatus and in the contralateral salivary glands.
评估前瞻性DIREKHT试验（ClinicalTrials.gov，NCT02528955）中针对头颈癌患者放疗去强化的放疗治疗计划。
纳入来自主要研究中心DIREKHT试验的前30例患者进行此分析。为每位患者计算源自方案的标准治疗计划和研究治疗计划。使用配对样本的学生t检验比较计划靶体积（PTV）的大小和危及器官的平均剂量。
在研究治疗计划中，包括原发肿瘤区域和同侧选择性颈部直至50 Gy剂量的平均PTV3为662 mL（标准差（SD）为±165 mL），因此显著小于标准治疗计划的PTV3（1166 mL（±266 mL SD））。与标准治疗计划相比，在研究治疗计划中，内侧和下咽缩肌、环咽肌、声门和声门上喉区域、杓状软骨、对侧主要唾液腺实现了超过10 Gy的高度显著剂量降低（<0.0001）。
放疗去强化导致计划靶体积减小，以及吞咽器官和对侧唾液腺出现临床相关的剂量降低。
