Yoon Han Gyul, Ahn Yong Chan, Oh Dongryul, Noh Jae Myoung, Park Seung Gyu, Nam Heerim, Ju Sang Gyu, Kwon Dongyeol, Park Seyjoon
Samsung Medical Center, Department of Radiation Oncology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Keimyung University Dongsan Medical Center, Department of Radiation Oncology, Keimyung University School of Medicine, Daegu 42601, Korea.
Cancers (Basel). 2021 Mar 27;13(7):1549. doi: 10.3390/cancers13071549.
To report the early clinical outcomes of combining intensity-modulated radiation therapy (IMRT) and intensity-modulated proton therapy (IMPT) in comparison with IMRT alone in treating oropharynx cancer (OPC) patients.
The medical records of 148 OPC patients who underwent definitive radiotherapy (RT) with concurrent systemic therapy, from January 2016 till December 2019 at Samsung Medical Center, were retrospectively reviewed. During the 5.5 weeks' RT course, the initial 16 (or 18) fractions were delivered by IMRT in all patients, and the subsequent 12 (or 10) fractions were either by IMRT in 81 patients (IMRT only) or by IMPT in 67 (IMRT/IMPT combination), respectively, based on comparison of adaptive re-plan profiles and availability of equipment. Propensity-score matching (PSM) was done on 76 patients (38 from each group) for comparative analyses.
With the median follow-up of 24.7 months, there was no significant difference in overall survival and progression free survival between groups, both before and after PSM. Before PSM, the IMRT/IMPT combination group experienced grade ≥ 3 acute toxicities less frequently: mucositis in 37.0% and 13.4% ( < 0.001); and analgesic quantification algorithm (AQA) in 37.0% and 19.4% ( = 0.019), respectively. The same trends were observed after PSM: mucositis in 39.5% and 15.8% ( = 0.021); and AQA in 47.4% and 21.1% ( = 0.016), respectively. In multivariate logistic regression, grade ≥ 3 mucositis was significantly less frequent in the IMRT/IMPT combination group, both before and after PSM ( = 0.027 and 0.024, respectively). AQA score ≥ 3 was also less frequent in the IMRT/IMPT combination group, both before and after PSM ( = 0.085 and 0.018, respectively).
In treating the OPC patients, with comparable early oncologic outcomes, more favorable acute toxicity profiles were achieved following IMRT/IMPT combination than IMRT alone.
报告调强放射治疗（IMRT）与调强质子治疗（IMPT）联合应用相较于单纯IMRT治疗口咽癌（OPC）患者的早期临床结果。
回顾性分析2016年1月至2019年12月在三星医疗中心接受确定性放疗（RT）并同步全身治疗的148例OPC患者的病历。在5.5周的放疗疗程中，所有患者最初的16（或18）分次由IMRT进行，随后的12（或10）分次，81例患者采用IMRT（仅IMRT组），67例患者采用IMPT（IMRT/IMPT联合组），这是基于适应性重新计划轮廓的比较和设备可用性决定的。对76例患者（每组38例）进行倾向评分匹配（PSM）以进行比较分析。
中位随访24.7个月，PSM前后两组的总生存期和无进展生存期均无显著差异。PSM前，IMRT/IMPT联合组≥3级急性毒性反应的发生率较低：黏膜炎分别为37.0%和13.4%（<0.001）；镇痛量化算法（AQA）分别为37.0%和19.4%（=0.019）。PSM后观察到相同趋势：黏膜炎分别为39.5%和15.8%（=0.021）；AQA分别为47.4%和21.1%（=0.016）。在多因素逻辑回归分析中，IMRT/IMPT联合组≥3级黏膜炎的发生率在PSM前后均显著较低（分别为=0.027和0.024）。IMRT/IMPT联合组AQA评分≥3的发生率在PSM前后也较低（分别为=0.085和0.018）。
在治疗OPC患者时，IMRT/IMPT联合应用与单纯IMRT相比，早期肿瘤学结果相当，但急性毒性反应情况更有利。
