Bandyopadhyay Anis, Ghosh Arnab Kumar, Chhatui Bappaditya, Bagchi Bidisha, Das Dhiman, Choudhury Alakananda, Rahamatulla Sk
Department of Radiotherapy, Nil Ratan Sarkar Medical College and Hospital, Kolkata, India.
Department of Radiotherapy, Medical College Kolkata, India.
Rep Pract Oncol Radiother. 2022 Dec 29;27(6):990-1000. doi: 10.5603/RPOR.a2022.0117. eCollection 2022.
Carcinoma of buccal mucosa forms a sizeable percentage of the diagnosed oral cavity cancers in India. There is limited data on elective treatment of the contralateral neck for well-lateralized carcinoma with no involved nodes in the contralateral neck. We conducted this study to compare locoregional control in patients treated with unilateral . bilateral neck irradiation.
48 patients with carcinoma of buccal mucosa were selected. Patients were divided into unilateral and bilateral arms based on radiation treatment of the ipsilateral or bilateral neck. All patients received adjuvant radiation with Cobalt 60 unit. Patient-specific and follow-up data were collected from records and dosimetric data from treatment planning system (TPS). Chi-square and unpaired t-test was used to compare data between arms and Kaplan Meier plot; Cox regression was used for survival analysis.
After a median follow-up of 23 months, 15 (31.3%) patients had developed disease recurrence, 8 and 7 in the unilateral and bilateral arms, respectively (p = 0.591). There was no contralateral neck failure during the follow-up period. The 2-year disease-free survival was 68.2% and 72.2% in the unilateral and bilateral arms, respectively. Among risk factors for disease recurrence, depth of invasion (DOI), delay in starting radiation and planning target volume (PTV) coverage were significant contributing factors. Cox multivariate regression suggested DOI and delay in starting radiation to be significant prognostic factors for disease-free survival (DFS).
Bilateral neck radiation does not provide any advantage over ipsilateral neck radiation for properly selected well lateralized buccal mucosal squamous cell carcinoma. Ipsilateral neck radiation facilitates better sparing of organs at risk.
在印度，颊黏膜癌在已确诊的口腔癌中占相当大的比例。对于对侧颈部无淋巴结转移的单侧颊黏膜癌，关于其对侧颈部选择性治疗的数据有限。我们开展这项研究以比较单侧和双侧颈部放疗患者的局部区域控制情况。
选取48例颊黏膜癌患者。根据同侧或双侧颈部的放射治疗情况，将患者分为单侧组和双侧组。所有患者均接受钴60单位的辅助放疗。从记录中收集患者特异性数据和随访数据，从治疗计划系统（TPS）中收集剂量学数据。采用卡方检验和非配对t检验比较两组数据，并绘制Kaplan Meier曲线；采用Cox回归进行生存分析。
中位随访23个月后，15例（31.3%）患者出现疾病复发，单侧组和双侧组分别为8例和7例（p = 0.591）。随访期间对侧颈部无失败病例。单侧组和双侧组的2年无病生存率分别为68.2%和72.2%。在疾病复发的危险因素中，浸润深度（DOI）、开始放疗的延迟时间和计划靶体积（PTV）覆盖情况是重要的影响因素。Cox多因素回归分析表明，DOI和开始放疗的延迟时间是无病生存（DFS）的重要预后因素。
对于适当选择的单侧颊黏膜鳞状细胞癌，双侧颈部放疗并不比同侧颈部放疗有任何优势。同侧颈部放疗有助于更好地保护危及器官。
