Burr Adam, Harari Paul, Wieland Aaron, Kimple Randall, Hartig Gregory, Witek Matthew
Department of Human Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Division of Otolaryngology and Head and Neck Surgery, Department of Surgery, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Radiat Oncol J. 2022 Dec;40(4):225-231. doi: 10.3857/roj.2022.00311. Epub 2022 Dec 2.
Optimal radiotherapy treatment volumes for patients with locally advanced hypopharynx squamous cell carcinoma should ensure maximal tumor coverage with minimal inclusion of normal surrounding structures. Here we evaluated the effectiveness of a direct 3-mm high-dose gross tumor volume to planning target volume expansion on clinical outcomes for hypopharynx cancers.
We performed a retrospective analysis of patients with hypopharynx carcinoma treated between 2004 and 2018 with primary radiotherapy using a direct high-dose gross tumor volume to planning target volume expansion and with or without concurrent systemic therapy. Diagnostic imaging of recurrences was co-registered with the planning CT. Spatial and volumetric analyses of contoured recurrences were compared with planned isodose lines. Failures were initially defined as in field, marginal, elective nodal, and out of field. Each failure was further classified as central high-dose, peripheral high-dose, central intermediate/low-dose, peripheral intermediate/low-dose, and extraneous. Clinical outcomes were analyzed by Kaplan-Meier estimation.
Thirty-six patients were identified. At a median follow-up at 52.4 months, estimated 5-year overall survival was 59.3% (95% confidence interval [CI], 36.3%-74.1%), 5-year local and nodal control was 71.7% (95% CI, 47.1%-86.3%) and 69.9% (95% CI, 57.0%-82.6%), respectively. The most common failure was in the high-dose primary target volume. The gastrostomy tube retention rate at 1 year among patients without recurrence was 13.0% (95% CI, 3.2%-29.7%).
Minimal high-dose target volume expansions for hypopharynx cancers were associated with favorable locoregional control. This approach may enable therapy intensification to improve clinical outcomes.
局部晚期下咽鳞状细胞癌患者的最佳放射治疗体积应确保最大程度地覆盖肿瘤，同时尽量减少对周围正常结构的累及。在此，我们评估了直接将3毫米高剂量大体肿瘤体积扩展至计划靶体积对下咽癌临床结局的有效性。
我们对2004年至2018年间接受原发性放射治疗的下咽癌患者进行了回顾性分析，这些患者采用直接高剂量大体肿瘤体积扩展至计划靶体积的方法，且接受或未接受同步全身治疗。复发的诊断性影像与计划CT进行了配准。将勾画的复发灶的空间和体积分析与计划等剂量线进行比较。失败最初定义为野内、边缘、选择性淋巴结和野外。每个失败进一步分为中央高剂量、外周高剂量、中央中/低剂量、外周中/低剂量和无关。通过Kaplan-Meier估计分析临床结局。
共纳入36例患者。中位随访52.4个月时，估计5年总生存率为59.3%（95%置信区间[CI]，36.3%-74.1%），5年局部和淋巴结控制率分别为71.7%（95%CI，47.1%-86.3%）和69.9%（95%CI，57.0%-82.6%）。最常见的失败发生在高剂量原发靶体积内。无复发患者1年时胃造瘘管保留率为13.0%（95%CI，3.2%-29.7%）。
下咽癌最小高剂量靶体积扩展与良好的局部区域控制相关。这种方法可能使治疗强化以改善临床结局。
