Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States of America.
Department of Radiation Oncology, Upstate Medical University, Syracuse, NY, United States of America.
PLoS One. 2020 Apr 10;15(4):e0231042. doi: 10.1371/journal.pone.0231042. eCollection 2020.
Positron-emission tomography (PET) has improved identification of the primary tumor as well as occult nodal burden in cancer of the head and neck. Nevertheless, there are still patients where the primary tumor cannot be located. In these situations, the standard of care is comprehensive head and neck radiation therapy however it is unclear whether this is necessary. This study examines the effects of radiation treatment volume on outcomes among using data from two cancer centers in unknown primary carcinoma of the head and neck.
Patients received unilateral (n = 34), or bilateral radiation (n = 28). Patient factors such as age, gender, smoking history, and patterns of failure were compared using Mann Whitney U and Chi Square. Overall survival (OS) and disease free survival (DFS) trends were estimated using Kaplan-Meier survival curves. Effect of treatment volume on survival was examined using multivariate cox proportional hazard regression model.
No significant differences were observed in the frequency of local (p = 0.32), regional (p = 0.50), or distant (p = 0.76) failures between unilateral and bilateral radiation therapy. By Kaplan-Meier estimates, OS (3-year OS bilateral = 71.67%, unilateral = 77.90%, p = 0.50) and DFS (3-year DFS bilateral = 77.92%, unilateral = 69.43%, p = 0.63) were similar between the two treatment approaches. Lastly, multivariate analysis did not demonstrate any significant differences in outcome by treatment volumes (OS: HR = 0.74, 95% CI: 0.31, 1.81, p = 0.51; DFS: HR: 0.68, 95% CI: 0.24, 1.93, p = 0.47).
Unilateral radiation therapy compared with bilateral produced similar survival.
正电子发射断层扫描（PET）提高了对头颈癌原发肿瘤和隐匿性淋巴结负担的识别能力。尽管如此，仍有一些患者无法定位原发肿瘤。在这些情况下，标准治疗是全面的头颈部放射治疗，但尚不清楚这是否有必要。本研究通过两个癌症中心的数据，研究了未知原发性头颈部癌中放射治疗体积对结果的影响。
患者接受单侧（n=34）或双侧（n=28）放射治疗。使用曼惠特尼 U 检验和卡方检验比较患者的年龄、性别、吸烟史和失败模式等因素。使用 Kaplan-Meier 生存曲线估计总生存率（OS）和无病生存率（DFS）趋势。使用多变量 Cox 比例风险回归模型检查治疗体积对生存的影响。
单侧和双侧放射治疗在局部（p=0.32）、区域（p=0.50）或远处（p=0.76）失败的频率上无显著差异。根据 Kaplan-Meier 估计，OS（双侧 3 年 OS=71.67%，单侧 77.90%，p=0.50）和 DFS（双侧 3 年 DFS=77.92%，单侧 69.43%，p=0.63）在两种治疗方法之间相似。最后，多变量分析未显示治疗体积对结果有任何显著差异（OS：HR=0.74，95%CI：0.31，1.81，p=0.51；DFS：HR：0.68，95%CI：0.24，1.93，p=0.47）。
与双侧相比，单侧放射治疗产生了相似的生存率。
