Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH.
Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX.
Am J Clin Oncol. 2022 Oct 1;45(10):422-426. doi: 10.1097/COC.0000000000000940. Epub 2022 Sep 9.
Unilateral radiation to cervical nodes has been used as a de-escalation strategy in well-lateralized tonsil cancers. The efficacy of this approach with multiple ipsilateral nodes is not established. The study hypothesis was that unilateral radiation for American Joint Committee on Cancer (AJCC)-7 T1-2N2b tonsillar cancer results in a low rate of contralateral nodal failure.
This study was a retrospective chart review of patients with AJCC-7 T1-2N2b tonsillar cancer from 2 academic institutions who were treated with unilateral radiation. The primary endpoint was the contralateral nodal failure rate. Locoregional control, overall survival, and the need for gastrostomy tube placement were additional endpoints.
The study cohort included 66 patients treated between 2005 and 2016. The median follow-up time was 80.9 months; contralateral nodal failure occurred in 2/66 (3.0%) patients at 4.1 and 20.9 months, respectively. Both patients underwent salvage treatment with long-term subsequent survival. Overall locoregional control at both 2 and 5 years was 93.9% and the median duration of control was not reached. Overall survival at 5 years was 92.4%.
The use of unilateral radiation for AJCC-7 T1-2N2b tonsillar cancer resulted in low rates of contralateral nodal failure. This outcome demonstrates the safety of considering unilateral radiation treatment in patients with a relatively high ipsilateral nodal burden.
在单侧辐射到颈部淋巴结已经作为一种降级策略在肿瘤侧化的扁桃体癌。这种方法在多个同侧淋巴结的疗效尚未确定。研究假设单侧放疗对 AJCC-7 T1-2N2b 扁桃体癌的疗效导致对侧淋巴结失败率低。
这是一项回顾性研究，对来自 2 所学术机构的 AJCC-7 T1-2N2b 扁桃体癌患者进行了单侧放疗。主要终点是对侧淋巴结失败率。局部区域控制、总生存率和胃造口管放置的需要是其他终点。
研究队列包括 66 例患者，治疗时间为 2005 年至 2016 年。中位随访时间为 80.9 个月；对侧淋巴结失败分别发生在 2/66（3.0%）患者中，分别为 4.1 个月和 20.9 个月。两名患者均接受了挽救性治疗，长期生存。2 年和 5 年的总局部区域控制率分别为 93.9%和无疾病控制中位时间未达到。5 年总生存率为 92.4%。
单侧放疗治疗 AJCC-7 T1-2N2b 扁桃体癌，对侧淋巴结失败率低。这一结果表明，对于同侧淋巴结负荷较高的患者，考虑单侧放疗治疗是安全的。
