调强放疗联合计划伽玛刀放射外科推量治疗头颈部广泛疾病且临近关键结构
Intensity-modulated radiotherapy with planned Gamma Knife radiosurgery boost for head and neck cancer with extensive disease in proximity to critical structures.
机构信息
Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
Department Otolaryngology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
出版信息
Head Neck. 2022 Nov;44(11):2571-2578. doi: 10.1002/hed.27176. Epub 2022 Sep 1.
BACKGROUND
To describe intensity-modulated radiotherapy (IMRT) with Gamma Knife Radiosurgery (GKRS) boost for locally advanced head and neck cancer (HNC) with disease near dose-limiting structures.
METHODS
Patients with HNC treated with IMRT/GKRS as part of a combined modality approach between 2011 and 2021 were reviewed. Local control, overall survival and disease-specific survival were estimated using the Kaplan Meier method.
RESULTS
Twenty patients were included. Nineteen patients had T3-4 tumors. Median follow-up was 26.3 months. GKRS site control was 95%. Two patients progressed at the treated primary site, one patient failed at the edge of the GKRS treatment volume, with no perineural or intracranial failure. 2-year OS was 94.7% (95% CI: 85.2%-100%). Concurrent chemotherapy was given in nine patients (45%). One patient (5%) received induction/concurrent chemotherapy. Brain radionecrosis occurred in three patients, one of which was biopsy-proven.
CONCLUSIONS
IMRT plus GKRS boost results in excellent disease control near critical structures with minimal toxicity.
背景
描述调强放疗（IMRT）联合伽玛刀放射外科（GKRS）治疗局部晚期头颈部癌症（HNC），这些癌症临近剂量限制结构。
方法
回顾了 2011 年至 2021 年期间，采用调强放疗/伽玛刀放射外科综合治疗的局部晚期头颈部癌症患者。采用 Kaplan-Meier 方法估计局部控制、总生存率和疾病特异性生存率。
结果
共纳入 20 例患者。19 例患者的肿瘤为 T3-4 期。中位随访时间为 26.3 个月。GKRS 部位控制率为 95%。2 例患者在治疗的原发部位进展，1 例患者在 GKRS 治疗体积边缘失败，无神经周围或颅内失败。2 年 OS 为 94.7%（95%CI：85.2%-100%）。9 例（45%）患者接受同期化疗。1 例（5%）患者接受诱导/同期化疗。3 例患者发生脑放射性坏死，其中 1 例经活检证实。
结论
在紧邻关键结构的部位，调强放疗联合 GKRS 推量治疗可获得极好的疾病控制，且毒性极小。
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