Gérard M, Le Guevelou J, Jacksic N, Lequesne J, Bastit V, Géry B, Jeanne C, Batalla A, Lacroix J, Kammerer E, Lasne-Cardon A, Thariat J
Normandie Université, 3, rue General-Harris, 14000 Caen, France; Université de Caen Normandie (UniCaen), esplanade de la Paix, CS 14032, 14032 Caen cedex, France; Commissariat à l'énergie atomique (CEA), 3, rue General-Harris, 14000 Caen, France; Centre national pour la recherche scientifique (CNRS), 3, rue General-Harris, 14000 Caen, France; CervOxy group, Imagerie et stratégies thérapeutiques des pathologies cérébrales et tumorales (ISTCT), boulevard Henri-Becquerel, BP 5229, 14074 Caen cedex 5, France; Groupement d'intérêt public Cyceron, boulevard Henri-Becquerel, BP 5229, 14074 Caen cedex 5, France; Department of radiation oncology, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France.
Department of radiation oncology, centre lutte contre le cancer François-Baclesse, 3, rue General-Harris, 14000 Caen, France.
Cancer Radiother. 2020 Dec;24(8):851-859. doi: 10.1016/j.canrad.2020.06.024. Epub 2020 Oct 29.
Flaps are increasingly used during reconstructive surgery of head and neck cancers to improve functional outcomes. There are no guidelines as to whether the whole flap or its anastomotic border should be included in the primary tumour target volume of postoperative radiotherapy to prevent local relapses. Relapse and toxicity rates can increase substantially if the whole flap received full dose. Our aim was to determine whether flaps were included in the primary tumour target volume and to report the patterns of relapse and toxicity.
Consecutive patients in 2014 through 2016, with or without a flap, receiving postoperative radiotherapy were selected in a retrospective monocentric control study. Flaps were homogenously delineated blind to treating radiation oncologists using a flap-specific atlas. Tumour recurrence, acute and late toxicity were evaluated using univariate and propensity score analyses.
A hundred patients were included; 54 with a flap. Median flap volume included in the tumour volume was 80.9%. Twelve patients experienced local recurrences: six with a flap, among whom two within their flap (3.7%). Patients with flaps had larger median tumour volumes to be irradiated (25cm versus 58cm, p<0.001) and higher acute/late toxicity rates (p<0.001) even after adjustment on biases (more advanced T stage, oral cavity, active smoking in patients with flaps). Locoregional recurrence and survival rates were similar between patients with/without a flap.
Recurrences within a flap were rare in this series when including the whole flap body in the 60Gy-clinical target volume but inclusion of the flap in the primary tumour target volume increased toxicity. Multicentric studies are warranted.
在头颈癌重建手术中，皮瓣的应用日益增多，以改善功能预后。对于术后放疗的原发肿瘤靶体积中是否应纳入整个皮瓣或其吻合边界以预防局部复发，目前尚无指南。如果整个皮瓣接受全剂量放疗，复发率和毒性率可能会大幅增加。我们的目的是确定皮瓣是否被纳入原发肿瘤靶体积，并报告复发和毒性模式。
在一项回顾性单中心对照研究中，选取了2014年至2016年接受术后放疗的连续患者，无论有无皮瓣。使用皮瓣专用图谱，在对放疗肿瘤学家不知情的情况下，对皮瓣进行均匀勾画。使用单变量和倾向评分分析评估肿瘤复发、急性和晚期毒性。
共纳入100例患者；54例有皮瓣。纳入肿瘤体积的皮瓣中位体积为80.9%。12例患者出现局部复发：6例有皮瓣，其中2例在皮瓣内复发（3.7%）。即使在对偏倚进行调整后（皮瓣患者T分期更晚、口腔癌、主动吸烟），有皮瓣的患者中位受照射肿瘤体积更大（25cm对58cm，p<0.001），急性/晚期毒性率更高（p<0.001）。有/无皮瓣患者的局部区域复发率和生存率相似。
在本系列研究中，当将整个皮瓣体纳入60Gy临床靶体积时，皮瓣内复发很少见，但将皮瓣纳入原发肿瘤靶体积会增加毒性。需要进行多中心研究。
