Lyu Shaowen, Wu Zheng, Xie Dehuan, Long Zhiqing, Zhong Rui, Lei Wang, Cheng Wanqin, Hu Jiang, Liu Xuekui, Xie Chuanmiao, Su Yong
Department of Radiation Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
J Cancer Res Clin Oncol. 2022 Apr;148(4):921-930. doi: 10.1007/s00432-021-03646-y. Epub 2021 May 10.
No international consensus has been reached regarding delineation of postoperative intensity-modulated radiotherapy (PO-IMRT) clinical target volumes (CTV) for major salivary gland carcinoma (SGC). The purpose of this article was to report our experience according to surgical principles.
Between June 2010 and June 2018, 54 consecutive patients were enrolled. Reserved tissues around the margin of resection that were less than 5 mm from the invasive tumour edge before surgery were defined as high-risk clinical target volumes (CTV-HD), those less than 10 mm away were defined as medium-risk CTV (CTV1), and those 10-20 mm away were defined as low-risk CTV (CTV2), and were irradiated with 63-65 Gy, 59.5-61 Gy, and 45-54 Gy, respectively. Target volume distributions of reserved tissues were analysed and actuarial estimates of overall survival (OS), recurrence-free survival (RFS) and distant metastasis-free survival (DMFS) were obtained with the Kaplan-Meier method.
In parotid gland tumours, the percentages of defined CTV-HD in the styloid process, mandibular ramus, posterior venter of the digastric muscle, carotid sheath and stylomastoid foramen reached 34.29%, 25.71%, 54.29%, 40.00%, and 37.10%, respectively. The median follow-up was 33 months (range, 5-98 months). The 3-year and 5-year Kaplan-Meier estimates of OS, RFS and DMFS were 85.4% and 77.8%, 97.4%, and 97.4%, and 82.0% and 82.0%, respectively.
It is feasible to delineate CTVs according to distances between various reserved tissues and the primary tumour edge before operation.
关于大唾液腺癌（SGC）术后调强放疗（PO-IMRT）临床靶区（CTV）的勾画，目前尚未达成国际共识。本文旨在根据手术原则报告我们的经验。
2010年6月至2018年6月，连续纳入54例患者。术前距浸润性肿瘤边缘小于5mm的手术切缘周围保留组织定义为高危临床靶区（CTV-HD），距肿瘤边缘小于10mm的组织定义为中危CTV（CTV1），距肿瘤边缘10-20mm的组织定义为低危CTV（CTV2），分别给予63-65Gy、59.5-61Gy和45-54Gy的照射剂量。分析保留组织的靶区分布，并采用Kaplan-Meier法获得总生存（OS）、无复发生存（RFS）和无远处转移生存（DMFS）的精算估计值。
在腮腺肿瘤中，茎突、下颌支、二腹肌后腹、颈动脉鞘和茎乳孔中定义的CTV-HD百分比分别达到34.29%、25.71%、54.29%、40.00%和37.10%。中位随访时间为33个月（范围5-98个月）。OS、RFS和DMFS的3年和5年Kaplan-Meier估计值分别为85.4%和77.8%、97.4%和97.4%、82.0%和82.0%。
根据术前各保留组织与原发肿瘤边缘的距离勾画CTV是可行的。
