Kovarik Josef, Kelly Charles, Cunnell Michelle, Jamil Fatima, Iqbal Muhammad Shahid
Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
Department of Medical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
Int Arch Otorhinolaryngol. 2022 Jul 11;27(1):e16-e23. doi: 10.1055/s-0042-1745855. eCollection 2023 Jan.
Radiotherapy provides excellent outcome in early stage glottic cancer; however, the optimal radiotherapy dose fractionation remains unknown. To investigate the outcome of patients with T2N0M0 treated with either hypofractionated (HypoFxn) or conventionally fractionated radical (ConFxn) radiotherapy. According to our institutional protocol, patients with T2N0M0 glottic cancer can be treated either with ConfFxn or HypoFxn radiotherapy, as per clinician's and patient's choice, following shared decision making discussing the advantages and disadvantages of both modalities. A total of 77 patients with T2N0M0 squamous cell carcinoma of glottis treated with either HypoFxn 55Gy in 20 fractions ( = 19) or ConFxn 63 to 65Gy in 30 fractions ( = 58) were included. With median follow-up of 3.4 years, there was no significant difference in disease-free survival (median: HypoFxn = 65.2 months, and ConFxn = 75.3 months; = 0.874), local recurrence free survival rates (median: HypoFxn = 78.8 months vs. ConFxn = 81.2 months; = 0.274), and overall survival (median: HypoFxn = 65.9 months vs. ConFxn = 67.7 months; = 0.532). Elective neck irradiation was given to 43 patients, all in the ConFxn group, and this was associated with poorer local control ( = 0.027). The use of radiotherapy modality, three-dimensional conformal radiotherapy (3DRT) versus intensity modulated radiotherapy (IMRT), was not a prognostic factor ( = 0.36). In the HypoFxn group, grade III acute dysphagia requiring nasogastric tube was 16%, compared with 25% in the ConFxn group ( = 0.446). HypoFxn radiotherapy provides a comparable treatment outcome with acceptable toxicity. The addition of prophylactic irradiation of the neck lymph nodes has no impact on regional control.
放射治疗在早期声门癌中疗效显著；然而，最佳的放射治疗剂量分割方案仍不明确。
为了研究接受大分割（HypoFxn）或常规分割根治性（ConFxn）放射治疗的T2N0M0患者的治疗结果。
根据我们机构的方案，T2N0M0声门癌患者可根据临床医生和患者的选择，在共同决策讨论两种治疗方式的优缺点后，接受ConFxn或HypoFxn放射治疗。共纳入77例T2N0M0声门鳞状细胞癌患者，其中19例接受HypoFxn，20次分割，总剂量55Gy；58例接受ConFxn，30次分割，总剂量63至65Gy。
中位随访3.4年，无病生存率（中位：HypoFxn = 65.2个月，ConFxn = 75.3个月；P = 0.874）、无局部复发生存率（中位：HypoFxn = 78.8个月 vs. ConFxn = 81.2个月；P = 0.274）和总生存率（中位：HypoFxn = 65.9个月 vs. ConFxn = 67.7个月；P = 0.532）均无显著差异。43例患者接受了选择性颈部照射，均在ConFxn组，这与较差的局部控制相关（P = 0.027）。放射治疗方式，三维适形放疗（3DRT）与调强放疗（IMRT）的使用，不是一个预后因素（P = 0.36）。在HypoFxn组，需要鼻胃管的III级急性吞咽困难发生率为16%，而ConFxn组为25%（P = 0.446）。
大分割放射治疗提供了相当的治疗效果且毒性可接受。预防性颈部淋巴结照射对区域控制无影响。
