人乳头瘤病毒口咽癌：辅助治疗的积极降阶梯治疗

Human papillomavirus oropharynx carcinoma: Aggressive de-escalation of adjuvant therapy.

作者信息

Moore Eric J, Van Abel Kathryn M, Routman David M, Lohse Christine M, Price Katharine A R, Neben-Wittich Michelle, Chintakuntlawar Ashish V, Price Daniel L, Kasperbauer Jan L, Garcia Joaquin J, Hinni Michael L, Patel Samir H, Janus Jeffrey R, Foote Robert L, Ma Dan J

机构信息

Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.

Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA.

出版信息

Head Neck. 2021 Jan;43(1):229-237. doi: 10.1002/hed.26477. Epub 2020 Sep 23.

DOI:10.1002/hed.26477

PMID:32969095

Abstract

BACKGROUND

Aggressive dose de-escalated adjuvant radiation therapy (RT) in patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC).

METHODS

Patients with HPV(+)OPSCC on a phase II clinical trial of primary surgery and neck dissection followed by dose de-escalated RT (N = 79) were compared with a cohort of patients who received standard adjuvant therapy (N = 115). Local recurrence-free, regional recurrence-free, distant metastases-free survival, and progression-free survival (PFS) were assessed.

RESULTS

Of 194 patients, 23 experienced progression at a median of 1.1 years following surgery (interquartile range [IQR] 0.7-2.0; range 0.3-5.4); 10 patients in the de-escalated cohort and 13 patients in the standard cohort. The 3-year PFS rate for the de-escalated cohort was 87%, and in the standard cohort was 90% (hazard ratio [HR] 1.18, 95% confidence interval (CI) [0.50-2.75]).

CONCLUSION

Patients with HPV(+)OPSCC who undergo surgical resection and neck dissection and meet criteria for adjuvant therapy can undergo aggressive dose de-escalation of RT without increasing risk of progression locally, regionally or at distant sites.

摘要

背景

人乳头瘤病毒相关口咽鳞状细胞癌（HPV(+)OPSCC）患者采用积极的剂量递减辅助放疗（RT）。

方法

将79例接受一期手术和颈部清扫术后进行剂量递减放疗的HPV(+)OPSCC患者与115例接受标准辅助治疗的患者队列进行比较。评估局部无复发生存率、区域无复发生存率、远处无转移生存率和无进展生存率（PFS）。

结果

194例患者中，23例在术后中位1.1年出现进展（四分位间距[IQR]0.7 - 2.0；范围0.3 - 5.4）；剂量递减队列中有10例患者，标准队列中有13例患者。剂量递减队列的3年PFS率为87%，标准队列中为90%（风险比[HR]1.18，95%置信区间[CI][0.50 - 2.75]）。