在头颈部黏膜黑色素瘤系列中进行的根治性碳离子放疗：多学科联合探索未来之路。

Curative carbon ion radiotherapy in a head and neck mucosal melanoma series: Facing the future within multidisciplinarity.

机构信息

Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.

Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133 Milano, Italy.

出版信息

Radiother Oncol. 2024 Jan;190:110003. doi: 10.1016/j.radonc.2023.110003. Epub 2023 Nov 11.

DOI:10.1016/j.radonc.2023.110003

PMID:37956889

Abstract

PURPOSE

To evaluate efficacy and toxicity of carbon ion radiotherapy (CIRT) in locally advanced head and neck mucosal melanoma (HNMM) patients treated at our Institute.

MATERIALS AND METHODS

Between June 2013 and June 2020, 40 HNMM patients were treated with CIRT. Prescription dose was 65.6-68.8 Gy relative biological effectiveness [RBE] in 16 fractions. Twelve (30%) patients received only biopsy, 28 (70%) surgical resection before CIRT. Immunotherapy was administered before and/or after CIRT in 45% of patients, mainly for distant progression (89%).

RESULTS

Median follow-up was 18 months. 2-year Local Relapse Free Survival (LRFS), Overall Survival (OS), Progression Free Survival (PFS) and Distant Metastasis Free Survival (DMFS) were 84.5%, 58.6%, 33.2% and 37.3%, respectively. At univariate analysis, LRFS was significantly better for non-recurrent status, < 2 surgeries before CIRT and treatment started < 9 months from the initial diagnosis, with no significant differences for operated versus unresected patients. After relapse, immunotherapy provided longer median OS (17 months vs 3.6, p-value<0.001). Late toxicity ≥ G3 (graded with CTCAE 5.0 scale) was reported in 10% of patients.

CONCLUSION

CIRT in advanced HNMM patients is safe and locally effective. Prospective trials are warranted to assess the role of targeted/immune- systemic therapy to improve OS.

摘要

目的

评估我院局部晚期头颈部黏膜黑色素瘤（HNMM）患者接受碳离子放疗（CIRT）的疗效和毒性。

材料和方法

2013 年 6 月至 2020 年 6 月，40 例 HNMM 患者接受 CIRT 治疗。处方剂量为 65.6-68.8Gy 相对生物效应[RBE]，共 16 次分割。12 例（30%）患者仅接受活检，28 例（70%）患者在 CIRT 前接受手术切除。45%的患者在 CIRT 前后接受免疫治疗，主要用于远处进展（89%）。

结果

中位随访时间为 18 个月。2 年局部无复发生存率（LRFS）、总生存率（OS）、无进展生存率（PFS）和远处转移无复发生存率（DMFS）分别为 84.5%、58.6%、33.2%和 37.3%。单因素分析显示，无复发状态、CIRT 前<2 次手术和诊断后<9 个月开始治疗的患者 LRFS 明显更好，手术与未手术患者无显著差异。复发后，免疫治疗提供了更长的中位 OS（17 个月 vs 3.6，p 值<0.001）。10%的患者报告有≥G3 级（根据 CTCAE 5.0 分级）的晚期毒性。