Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.
Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.
Radiother Oncol. 2021 Jan;154:70-75. doi: 10.1016/j.radonc.2020.08.013. Epub 2020 Aug 28.
To determine the outcomes of oral cavity squamous cell cancer (OSCC) patients treated with non-surgical approach i.e. definitive intensity-modulated radiation therapy (IMRT).
All OSCC patients treated radically with IMRT (without primary surgery) between 2005-2014 were reviewed in a prospectively collected database. OSCC patients treated with definitive RT received concurrent chemotherapy except for early stage patients or those who declined or were unfit for chemotherapy. The 5-year local, and regional, distant control rates, disease-free, overall, and cancer-specific survival, and late toxicity were analyzed.
Among 1316 OSCC patients treated with curative-intent; 108 patients (8%) received non-operative management due to: medical inoperability (n = 14, 13%), surgical unresectability (n = 8, 7%), patient declined surgery (n = 15, 14%), attempted preservation of oral structure/function in view of required extensive surgery (n = 53, 49%) or extensive oropharyngeal involvement (n = 18, 17%). Sixty-eight (63%) were cT3-4, 38 (35%) were cN2-3, and 38 (35%) received concurrent chemotherapy. With a median follow-up of 52 months, the 5-year local, regional, distant control rate, disease-free, overall, and cancer-specific survival were 78%, 92%, 90%, 42%, 50%, and 76% respectively. Patients with cN2-3 had higher rate of 5-year distant metastasis (24% vs 3%, p = 0.001), with detrimental impact on DFS (p = 0.03) and OS (p < 0.02) on multivariable analysis. Grade ≥ 3 late toxicity was reported in 9% of patients (most common: grade 3 osteoradionecrosis in 6%).
Non-operative management of OSCC resulted in a meaningful rate of locoregional control, and could be an alternative curative approach when primary surgery would be declined, unsuitable or unacceptably delayed.
确定接受非手术治疗（即确定性调强放疗）的口腔鳞状细胞癌（OSCC）患者的治疗结果。
回顾性分析 2005 年至 2014 年间接受根治性调强放疗（未行原发手术）的所有 OSCC 患者的前瞻性数据库。接受确定性放疗的 OSCC 患者除早期患者或拒绝或不适合化疗的患者外，均接受同期化疗。分析 5 年局部、区域、远处控制率、无病生存率、总生存率和癌症特异性生存率，以及晚期毒性。
在 1316 例接受根治性治疗的 OSCC 患者中，由于以下原因，有 108 例（8%）接受了非手术治疗：因医学原因不能手术（n=14，13%）、手术无法切除（n=8，7%）、患者拒绝手术（n=15，14%）、为了保留口腔结构/功能而进行广泛手术（n=53，49%）或广泛口咽受累（n=18，17%）。68 例（63%）为 cT3-4，38 例（35%）为 cN2-3，38 例（35%）接受同期化疗。中位随访 52 个月后，5 年局部、区域、远处控制率、无病生存率、总生存率和癌症特异性生存率分别为 78%、92%、90%、42%、50%和 76%。cN2-3 患者 5 年远处转移率较高（24% vs 3%，p=0.001），多变量分析显示对无病生存率（p=0.03）和总生存率（p<0.02）有不利影响。9%的患者报告有≥3 级晚期毒性（最常见的是 6 例 3 级放射性骨坏死）。
OSCC 的非手术治疗可获得有意义的局部区域控制率，在原发手术被拒绝、不适合或不可接受地延迟时，可作为一种替代的根治性治疗方法。
