Department of Oncology Radiotherapy, Centre Georges-François-Leclerc, Dijon, France.
Department of Oncology Radiotherapy, Habib Bourguiba Central University Hospital, Sfax, Tunisia.
Technol Cancer Res Treat. 2020 Jan-Dec;19:1533033820905826. doi: 10.1177/1533033820905826.
To evaluate the patterns of failure in patients treated for head and neck carcinoma of unknown primary and to discuss treatment practices concerning radiotherapy target volumes definition and dose prescription.
Eleven patients presenting a locoregional recurrence after head and neck carcinoma of unknown primary treatment with curative-intent radiochemotherapy performed between 2007 and 2017 in the departments of radiation oncology of 2 French cancer institutes. Images of the computed tomography scan or the magnetic resonance imaging performed at the time of the recurrence were fused with those of the simulation computed tomography scan to delimit a volume corresponding to the recurrence and to define the area of relapse compared to the volumes treated.
Irradiation was unilateral in 6 cases and bilateral in 5 cases. The median time to onset of recurrence was 7.24 months (extreme 3-67.7 months). Six patients had only a neck node recurrence, 3 had a neck node and subsequent primary recurrence, and 1 had only a median subsequent primary recurrence. Only 1 patient had synchronous distance progression to local recurrence. All neck node recurrences were solitary and ipsilateral. The subsequent primary recurrences were in the oropharynx in 3 cases and in the contralateral oral cavity in one case. All neck node recurrences were into the irradiated volume. The subsequent primary recurrences were either within or in border of the irradiated volumes. The median of the mean dose, received by neck node recurrences, was 69.9 Gy and that of the mean dose, minimum dose, maximum dose, and dose received by 95% of the volume of recurrence was 66.7 Gy. For the primary relapses, the median of the mean dose was 52.1 Gy and that of the mean dose, minimum dose, maximum dose, and dose received by 95% of the volume of recurrence was 39.9 Gy.
All local nodal recurrences occurred at sites that received high radiotherapy doses and doses received by sites of eventual failure did not vary significantly from sites that remain in control.
评估头颈部不明原发灶癌患者治疗后的失败模式，并讨论与放射治疗靶区定义和剂量处方相关的治疗实践。
2007 年至 2017 年间，法国 2 家癌症研究所放射肿瘤科的 11 名头颈部不明原发灶癌患者接受根治性放化疗后出现局部区域复发。在复发时进行的计算机断层扫描或磁共振成像的图像与模拟计算机断层扫描的图像融合，以划定与复发相对应的体积，并定义与治疗体积相比的复发区域。
6 例为单侧照射，5 例为双侧照射。复发的中位时间为 7.24 个月（极端值为 3-67.7 个月）。6 例患者仅有颈部淋巴结复发，3 例患者有颈部淋巴结和随后的原发性复发，1 例仅有中位随后的原发性复发。仅有 1 例患者同时出现局部复发和远处转移。所有颈部淋巴结复发均为单发且同侧。随后的原发性复发分别发生在 3 例患者的口咽和 1 例患者的对侧口腔。所有颈部淋巴结复发均在照射体积内。随后的原发性复发位于照射体积内或边界内。颈部淋巴结复发的平均剂量为 69.9Gy，复发体积的平均剂量、最小剂量、最大剂量和 95%体积所接受的剂量分别为 66.7Gy。对于原发性复发，平均剂量为 52.1Gy，复发体积的平均剂量、最小剂量、最大剂量和 95%体积所接受的剂量分别为 39.9Gy。
所有局部淋巴结复发均发生在接受高放射剂量的部位，而最终失败部位的剂量与保持控制的部位的剂量没有显著差异。
