喉鳞状细胞癌放射治疗结果：托姆治疗中心的经验。
Results of radiotherapy in squamous cell laryngeal cancer: A tomotherapy center experience.
机构信息
Department of Radiation Oncology, Health Sciences University Erzurum Regional Training and Research Hospital, Caykara Street, Yakutiye-Erzurum, Turkey.
出版信息
Indian J Cancer. 2022 Jul-Sep;59(3):330-336. doi: 10.4103/ijc.IJC_786_19.
BACKGROUND
Laryngeal cancer is a common type of head and neck cancer (HNC). Radiotherapy (RT) is a mainstay for curative treatment. Intensity-modulated RT (IMRT) is a standard technique today, as it provides of higher survival and local control and lower normal tissue toxicity. One of IMRT devices is helical tomotherapy (HT). The HT treatment results of HNC patients have been reported in few studies. We aimed to investigate the results of squamous cell laryngeal carcinoma patients treated with helical tomotherapy.
METHODS
Forty-five laryngeal cancer patients were selected according to the inclusion criteria. Radiotherapy (RT) plans were set in the Hi-Art HT planning system. Image-gated RT (IGRT) technique was used. Appropriate patients received simultaneous cisplatin. Treatment response rates were evaluated at the post-RT third and sixth months. Survival times were calculated with the Kaplan-Meier method. The factors affecting the treatment results were evaluated using Log-rank and Cox regression tests. A P value of less than 0.05 was accepted as statistically significant.
RESULTS
The median age was 65 (28-84) years. The median symptom duration was 6 (1-60) months. The RT dose for the early and the locally advanced disease was median 63 Gy (60.75-66) and 66 Gy (60-70), respectively. The RT interruption was median two (0-20) days. The patients were followed up to 25 (1-45) months. Grade 2 xerostomia and dysphagia rates were 55% and 7%, respectively. The 3-year estimates of overall survival (OS), disease-free survival (DFS), metastasis-free survival (DMFS), and locoregional recurrence-free survival (RRFS) were 71.7%, 60.4%, 84.9%, and 68.5%, respectively. In univariate analysis, the presence of N2 disease was a negative prognostic for DFS (P = 0.05) and DMFS (P = 0.003). RT interruption >2 days was a negative prognostic for OS (P = 0.005), DFS (P = 0.02), and RRFS (P = 0.023). In the multivariate analysis, symptom duration >6 months was found to be the only significant factor for DFS (P < 0.05).
CONCLUSION
Intensity-modulated radiation with HT achieved comparable clinical outcomes with acceptable toxicity in laryngeal carcinoma.
背景
喉癌是一种常见的头颈部癌症（HNC）。放射治疗（RT）是主要的治疗方法。调强放疗（IMRT）是一种标准技术，因为它可以提高生存率和局部控制率，降低正常组织毒性。其中一种 IMRT 设备是螺旋断层放疗（HT）。已有少数研究报道了 HT 治疗头颈部癌症患者的结果。我们旨在研究接受螺旋断层放疗的鳞状细胞喉癌患者的治疗结果。
方法
根据纳入标准，选择了 45 例喉癌患者。在 Hi-Art HT 计划系统中设置放射治疗（RT）计划。使用图像引导放射治疗（IGRT）技术。合适的患者接受顺铂同步治疗。在 RT 后第三个和第六个月评估治疗反应率。采用 Kaplan-Meier 法计算生存时间。采用 Log-rank 和 Cox 回归检验评估影响治疗结果的因素。P 值小于 0.05 被认为具有统计学意义。
结果
中位年龄为 65（28-84）岁。中位症状持续时间为 6（1-60）个月。早期和局部晚期疾病的 RT 剂量分别为中位 63 Gy（60.75-66）和 66 Gy（60-70）。RT 中断中位时间为 2（0-20）天。患者随访时间为 25（1-45）个月。2 级口干和吞咽困难的发生率分别为 55%和 7%。3 年总生存率（OS）、无疾病生存率（DFS）、无转移生存率（DMFS）和局部区域无复发生存率（RRFS）的估计值分别为 71.7%、60.4%、84.9%和 68.5%。单因素分析显示，N2 疾病的存在对 DFS（P=0.05）和 DMFS（P=0.003）是一个负预后因素。RT 中断>2 天对 OS（P=0.005）、DFS（P=0.02）和 RRFS（P=0.023）是一个负预后因素。多因素分析显示，症状持续时间>6 个月是 DFS 的唯一显著影响因素（P<0.05）。
结论
HT 调强放疗在喉癌中取得了可接受的毒性和可比的临床结果。
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