预测头颈癌的大体肿瘤体积——超越轮廓勾画重新定义大体肿瘤体积

Prognosticating Gross Tumor Volume in Head-and-Neck Cancer - Redefining Gross Tumor Volume Beyond Contouring.

作者信息

Ahmed Imtiaz, Krishnamurthy Sapna, Vinchurkar Kumar

机构信息

Department of Radiation Oncology, JNMC and KLES, Dr. Prabhakar Kore Hospital and MRC, KAHER, Belgaum, Karnataka, India.

Department of Surgical Oncology, JNMC and KLES, Dr. Prabhakar Kore Hospital and MRC, KAHER, Belgaum, Karnataka, India.

出版信息

J Med Phys. 2023 Jan-Mar;48(1):68-73. doi: 10.4103/jmp.jmp_101_22. Epub 2023 Apr 18.

DOI:10.4103/jmp.jmp_101_22

PMID:37342608

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10277296/

Abstract

PURPOSE

Precision radiotherapy (RT) requires accurate delineation of gross tumor volumes (GTVs) for targeted dose delivery. Volumetric measurement of this GTV can predict the treatment outcomes. This volume has been limited for mere contouring and its potential as the prognostic factor is less explored.

MATERIALS AND METHODS

The data of 150 patients with oropharynx, hypopharynx, and larynx cancer undergoing curative intensity-modulated RT and weekly cisplatin between April 2015 and December 2019 were retrospectively evaluated. GTV-P (primary), GTV-N (nodal), and GTV-P+N were defined, and volumetric parameters were generated. Volume thresholds were defined as per the receiver operating characteristics, and the prognostic value of these tumor volumes (TVs) with respect to treatment outcomes was analyzed.

RESULTS

All patients completed 70 Gy, median chemotherapy cycles were six. Mean GTV-P, GTV-N, and GTV-P+N were 44.5 cc, 13.4 cc, and 57.9 cc, respectively. Oropharynx constituted 45% of cases. Forty-nine percent had Stage III disease. Sixty-six percent had complete response (CR). As per the defined cutoff values, GTV-P <30cc, GTV-N <4 cc, and GTV-P+N <50 cc had better CR rates with < 0.05 (82.6% vs. 51.9%; 74% vs. 58.4% and 81.5% vs. 47.8%, respectively). At median follow-up of 21.4 months, overall survival (OS) was 60% and median OS was 32.3 months. The median OS in patients with GTV-P <30 cc, GTV-N <4 cc, and GTV-P+N <50 cc was better with < 0.05 (59.2 vs. 21.4; 59.2 vs. 22.2, and 59.2 vs. 19.8 months, respectively).

CONCLUSION

GTV should not just be limited for contouring but its role as an important prognostic factor has to be recognized.

摘要

目的

精确放疗（RT）需要准确勾画大体肿瘤体积（GTV）以进行靶向剂量递送。该GTV的体积测量可预测治疗结果。此体积目前仅用于简单的轮廓勾画，其作为预后因素的潜力尚未得到充分探索。

材料与方法

回顾性评估了2015年4月至2019年12月期间150例接受根治性调强放疗和每周顺铂治疗的口咽癌、下咽癌和喉癌患者的数据。定义了原发灶GTV（GTV-P）、转移淋巴结GTV（GTV-N）和GTV-P+N，并生成了体积参数。根据受试者工作特征定义体积阈值，并分析这些肿瘤体积（TV）对治疗结果的预后价值。

结果

所有患者均完成了70 Gy的放疗，化疗周期中位数为6个。GTV-P、GTV-N和GTV-P+N的平均体积分别为44.5 cc、13.4 cc和57.9 cc。口咽癌占病例的45%。49%的患者为Ⅲ期疾病。66%的患者获得完全缓解（CR）。根据定义的临界值，GTV-P<30 cc、GTV-N<4 cc和GTV-P+N<50 cc的CR率更高，P<0.05（分别为82.6%对51.9%；74%对58.4%和81.5%对47.8%）。在中位随访21.4个月时，总生存率（OS）为60%，中位OS为32.3个月。GTV-P<30 cc、GTV-N<4 cc和GTV-P+N<50 cc患者的中位OS更好，P<0.05（分别为59.2个月对21.4个月；59.2个月对22.2个月，以及59.2个月对19.8个月）。