Rath Satyajeet, Gandhi Ajeet K, Rastogi Madhup, Khurana Rohini, Hadi Rahat, Singh Harikesh B, Nanda Sambit S, Azam Mohammad, Srivastava Anoop, Bharati Avinav, Mishra Surendra Prasad
Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Radiat Oncol J. 2020 Sep;38(3):189-197. doi: 10.3857/roj.2020.00458. Epub 2020 Sep 9.
Adjuvant radiotherapy (RT) in buccal mucosa cancers is guided by histopathological factors. The decision to treat ipsilateral or bilateral draining lymph node is on physician discretion and guidelines do not have a defined indication regarding this. We aimed to analyze the failure patterns and survival in buccal mucosa cancers treated with adjuvant ipsilateral RT.
One hundred sixteen cases of post-operative buccal mucosa cancers-pT3 or more, node positive, close margins (1-5 mm), lymphovascular invasion positive, perineural invasion positive, depth of invasion >4 mm-treated with RT to primary and ipsilateral nodes from May 2013 to May 2019 were retrospectively analyzed. Patients were treated to a dose of 60-66 Gy (44 Gy in the first phase and a coned down boost of 16-22 Gy in the second phase) with three-dimensional conformal radiotherapy on a linear accelerator. Primary end point was to assess control rates and secondary end point was to evaluate the overall survival (OS) and disease-free survival (DFS) outcomes.
Median age was 46 years with male; female ratio of 110:6. The edition of the American Joint Committee on Cancer stage distributions were I (3.4%), II (34.4%), III (24.1%), and IV (37.9%). At a median follow-up of 22 months, crude rates of local failure, regional failure, and contralateral neck failure were 9.4%, 10.3%, and 3.4%, respectively. The 2-year contralateral neck control rate was 94.9%. Pathological positive node portended poorer OS (86.6% vs. 68.6%; p = 0.015) and DFS (86.5% vs. 74.9%; p = 0.01).
Incidence of contralateral recurrence with ipsilateral irradiation in buccal mucosa cancers is low with descent survival outcomes, particularly in node negative cases.
颊黏膜癌的辅助放疗（RT）以组织病理学因素为指导。对同侧或双侧引流淋巴结进行治疗的决策由医生自行决定，且指南对此没有明确的指征。我们旨在分析接受辅助性同侧放疗的颊黏膜癌的失败模式和生存率。
回顾性分析2013年5月至2019年5月期间116例术后颊黏膜癌患者，这些患者为pT3及以上、淋巴结阳性、切缘接近（1 - 5毫米）、有淋巴管侵犯阳性、有神经周侵犯阳性、浸润深度>4毫米，接受了对原发灶和同侧淋巴结的放疗。患者在直线加速器上采用三维适形放疗，剂量为60 - 66 Gy（第一阶段44 Gy，第二阶段缩野加量16 - 22 Gy）。主要终点是评估控制率，次要终点是评估总生存（OS）和无病生存（DFS）结果。
中位年龄为46岁，男女比例为110:6。美国癌症联合委员会分期分布为I期（3.4%）、II期（34.4%）、III期（24.1%）和IV期（37.9%）。中位随访22个月时，局部失败、区域失败和对侧颈部失败的粗发生率分别为9.4%、10.3%和3.4%。2年对侧颈部控制率为94.9%。病理阳性淋巴结预示着较差的总生存（86.6%对68.6%；p = 0.015）和无病生存（86.5%对74.9%；p = 0.01）。
颊黏膜癌同侧照射时对侧复发的发生率较低，生存结果良好，尤其是在淋巴结阴性的病例中。
