Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
Department of Quantitative Health Sciences, Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona.
Int J Radiat Oncol Biol Phys. 2023 Jan 1;115(1):192-201. doi: 10.1016/j.ijrobp.2022.06.057. Epub 2022 Oct 26.
Our objective was to report the prospective results of mucosal sparing radiation therapy in human papillomavirus-related oropharyngeal squamous cell carcinoma.
From March 2016 through May 2019, patients were enrolled in this institutional review board-approved prospective cohort study at a multisite institution. Inclusion criteria included p16+ American Joint Committee on Cancer seventh edition pathologic T1 or T2, N1 to N3, and M0 oropharyngeal cancers. Proton therapy (PT) was delivered to at-risk nodal regions, excluding the primary mucosal site. Secondary to insurance denial for PT, intensity modulated radiation therapy (IMRT) was allowed. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module and Patient-Reported Outcomes Measurement Information System surveys (quality of life [QOL]) and modified barium swallowing impairment profiles (MBSImP) were obtained at baseline before radiation therapy, then 3 and 12 months after radiation therapy. Kaplan-Meier estimates were calculated for time-to-event clinical outcomes, and repeated measures mixed models were used to explore changes in QOL over time. A comparison of QOL and swallowing outcomes with standard-of-care treatment was analyzed.
There were 61 evaluable patients with a median follow-up of 38 months (range, 10-64); 44 (72%) were treated with PT and 17 (28%) were treated with IMRT. The 2-year local control, locoregional control, distant metastasis-free survival, and overall survival were 98%, 97%, 98%, and 100%, respectively. There were 6 grade ≥3 events related to treatment. Two IMRT patients required percutaneous endoscopic gastrostomy tube placement during treatment secondary to significant nausea due to dysgeusia. Patients noted significant QOL improvement over time in the pain, swallowing, speech, social eating, social contact, mouth opening, and use of pain medication domains (all P < .02). The MBSImP overall severity score as well as oral and pharyngeal impairment scores showed stability with no significant change over time. For the 44 patients treated with PT, the mean D95 to the primary target was 10.7 Gy (standard deviation = 12.5 Gy).
Mucosal sparing radiation is well tolerated in select resected human papillomavirus-related oropharyngeal squamous cell carcinoma with a low risk of recurrence at the mucosal primary site, a low rate of percutaneous endoscopic gastrostomy tube placement, and few radiation-related grade ≥3 adverse events.
本研究旨在报告 HPV 相关口咽鳞状细胞癌患者接受保留黏膜的放射治疗的前瞻性结果。
从 2016 年 3 月至 2019 年 5 月，在一家多院区机构进行了这项经机构审查委员会批准的前瞻性队列研究。纳入标准包括：p16+、AJCC 第 7 版病理学 T1 或 T2、N1 至 N3、M0 口咽癌。质子治疗（PT）用于高危淋巴结区域，不包括原发黏膜部位。由于保险公司拒绝接受 PT，允许使用调强放射治疗（IMRT）。在放射治疗前、放射治疗后 3 个月和 12 个月时，采用欧洲癌症研究与治疗组织头颈部模块和患者报告的结果测量信息系统问卷（生活质量[QOL]）和改良钡吞咽障碍概况（MBSImP）进行调查。采用 Kaplan-Meier 估计法计算时间事件临床结局，采用重复测量混合模型探讨 QOL 随时间的变化。分析与标准治疗相比 QOL 和吞咽结局。
61 例可评估患者的中位随访时间为 38 个月（范围，10-64 个月）；44 例（72%）接受 PT 治疗，17 例（28%）接受 IMRT 治疗。2 年局部控制率、局部区域控制率、无远处转移生存率和总生存率分别为 98%、97%、98%和 100%。有 6 例（10%）与治疗相关的≥3 级事件。由于味觉障碍引起的严重恶心，2 例 IMRT 患者在治疗期间需要放置经皮内镜胃造口管。患者在疼痛、吞咽、言语、社交进食、社交接触、张口和使用止痛药等方面的 QOL 随时间显著改善（均 P<.02）。MBSImP 总体严重程度评分以及口腔和咽部损伤评分随时间稳定，无显著变化。对于 44 例接受 PT 治疗的患者，原发靶区的 D95 平均值为 10.7 Gy（标准差为 12.5 Gy）。
在选择的 HPV 相关口咽鳞状细胞癌患者中，保留黏膜的放射治疗耐受性良好，原发黏膜部位复发风险低，经皮内镜胃造口管放置率低，与放射治疗相关的≥3 级不良事件少。
