Huang Qingting, Hu Jiyi, Hu Weixu, Gao Jing, Yang Jing, Qiu Xianxin, Lu Jiade Jay, Kong Lin
Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China.
Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.
Ann Transl Med. 2022 Nov;10(22):1197. doi: 10.21037/atm-20-5078.
To compare the efficacy and toxicity of adjuvant proton beam carbon-ion beam radiotherapy for head and neck cancers after radical resection and to explore the value of particle beam radiotherapy (PBRT) in postoperative radiotherapy for head and neck cancers.
Data from 38 head and neck cancer patients who received adjuvant PBRT after complete surgical resection at the Shanghai Proton and Heavy Ion Center (SPHIC) between October 2015 and March 2019 were retrospectively analyzed. In total, 18 patients received adjuvant proton beam therapy (54-60 GyE/27-30 fractions) and 20 received adjuvant carbon-ion radiotherapy (CIRT) (54-60 GyE/18-20 fractions). Survival rates were calculated using Kaplan-Meier analysis. Toxicity was evaluated according to the Common Terminology Criteria for Adverse Effects (version 4.03).
With a median follow-up time of 21 (range, 3-45) months, the 2-year overall survival (OS), progression-free survival (PFS), local-regional recurrence-free survival (LRRFS) and distant metastasis-free survival (DMFS) rates were 93.3%, 87.4%, 94.1%, and 90.7%, respectively, for the entire cohort. The rates after proton beam therapy CIRT were 94.1% 91.7% (P=0.96), 88.1% 86.2% (P=0.96), 94.4% 93.3% (P=0.97), and 88.1% 92.9% (P=0.57), respectively. Furthermore, 16 of the 18 (88.9%) patients developed acute grade I/II dermatitis (13 grade I; 3 grade II) after proton beam therapy, and only 7 of the 20 (35%) patients developed acute grade I dermatitis after CIRT (P=0.001). The incidence of acute grade I/II mucositis and xerostomia in proton and carbon ion cases were 45% 55% (P=0.75) and 56% 50% (P=0.87) respectively.
Adjuvant proton beam therapy and CIRT after radical surgical resection for head and neck cancers provided satisfactory therapeutic effectiveness, but no significant difference was observed between the two radiotherapy technologies. However, adjuvant CIRT was associated with a more favorable acute toxicity profile as compared to proton beam therapy with significantly lower frequency and severity of acute dermatitis observed.
比较头颈部癌根治性切除术后辅助质子束与碳离子束放疗的疗效和毒性，探讨粒子束放疗（PBRT）在头颈部癌术后放疗中的价值。
回顾性分析2015年10月至2019年3月在上海质子重离子中心（SPHIC）接受手术完全切除后辅助PBRT的38例头颈部癌患者的数据。总共18例患者接受辅助质子束治疗（54 - 60 GyE/27 - 30次分割），20例接受辅助碳离子放疗（CIRT）（54 - 60 GyE/18 - 20次分割）。采用Kaplan-Meier分析计算生存率。根据不良事件通用术语标准（第4.03版）评估毒性。
中位随访时间为21（范围3 - 45）个月，整个队列的2年总生存率（OS）、无进展生存率（PFS）、局部区域无复发生存率（LRRFS）和远处转移无复发生存率（DMFS）分别为93.3%、87.4%、94.1%和90.7%。质子束治疗与CIRT后的相应生存率分别为94.1%对91.7%（P = 0.96）、88.1%对86.2%（P = 0.96）、94.4%对93.3%（P = 0.97）和88.1%对92.9%（P = 0.57）。此外，18例患者中有16例（88.9%）在质子束治疗后出现急性I/II级皮炎（13例I级；3例II级），而20例患者中只有7例（35%）在CIRT后出现急性I级皮炎（P = 0.001）。质子和碳离子治疗病例中急性I/II级黏膜炎和口干的发生率分别为45%对55%（P = 0.75）和56%对50%（P = 0.87）。
头颈部癌根治性手术后辅助质子束治疗和CIRT提供了满意的治疗效果，但两种放疗技术之间未观察到显著差异。然而，与质子束治疗相比，辅助CIRT的急性毒性特征更有利，观察到急性皮炎的频率和严重程度显著更低。
