Koiwai Keiichiro, Hirasawa Dai, Sugimura Miyu, Endo Yuuki, Mizuhata Kai, Ina Hironobu, Fukazawa Ayumu, Kitoh Ryosuke, Sakai Hironori, Fujinaga Yasunari
Department of Radiology, Shinshu University, School of Medicine, Matsumoto, Japan.
Department of Otorhinolaryngology, Shinshu University, School of Medicine, Matsumoto, Japan.
Rep Pract Oncol Radiother. 2022 Dec 29;27(6):954-962. doi: 10.5603/RPOR.a2022.0120. eCollection 2022.
This study was performed to evaluate the impact of upgrade of radiotherapy system, including launch of intensity-modulated radiation therapy (IMRT), on the therapeutic outcomes.
Patients with head and neck (H&N) squamous cell carcinoma (SCC) who underwent postoperative radiotherapy at our hospital between June 2009 and July 2019 were retrospectively reviewed. In July 2014, we converted the radiotherapy technique for these patients from a 3-dimensional conformal radiotherapy (3D-CRT) to IMRT, along with the adoption of a meticulous planning policy and a few advanced procedures, including online imaging guidance.
A total of 136 patients (57 treated with the previous system and 79 treated with the upgraded system) were reviewed. There were significantly more patients with extracapsular extension in the upgraded-system group than the previous-system group (p = 0.0021). There were significantly fewer patients with ≥ Grade 2 acute and late adverse events in the upgraded-system group than the previous-system group. The differences in progression-free survival (PFS), distant metastasis-free survival (DFFS), locoregional progression-free survival (LRPFS), and overall survival (OS) between the two groups were not statistically significant (p = 0.8962, 0.9926, 0.6244, and 0.4827, respectively). Multivariate analysis revealed that the upgrade had neither positive nor negative impact on survival outcomes. Extracapsular extension was independently associated with decreased LRPFS and OS (p = 0.0499 and 0.0392, respectively).
The IMRT-centered upgrade was beneficial for the postoperative patients with H&N SCC, because survival outcomes were sustained with less toxicities.
本研究旨在评估放疗系统升级，包括调强放射治疗（IMRT）的推出，对治疗结果的影响。
回顾性分析2009年6月至2019年7月在我院接受术后放疗的头颈部（H&N）鳞状细胞癌（SCC）患者。2014年7月，我们将这些患者的放疗技术从三维适形放疗（3D-CRT）转换为IMRT，同时采用了细致的计划策略和一些先进的程序，包括在线影像引导。
共纳入136例患者（57例接受先前系统治疗，79例接受升级系统治疗）。升级系统组中出现包膜外侵犯的患者明显多于先前系统组（p = 0.0021）。升级系统组中发生≥2级急性和晚期不良事件的患者明显少于先前系统组。两组之间的无进展生存期（PFS）、无远处转移生存期（DFFS）、局部区域无进展生存期（LRPFS）和总生存期（OS）差异无统计学意义（分别为p = 0.8962、0.9926、0.6244和0.4827）。多因素分析显示，升级对生存结果既无正面影响也无负面影响。包膜外侵犯与LRPFS和OS降低独立相关（分别为p = 0.0499和0.0392）。
以IMRT为中心的升级对H&N SCC术后患者有益，因为在毒性较小的情况下生存结果得以维持。
