Chen Xuguang Scott, Sher David J, Sullivan Christopher Blake, Repka Michael C, Shen Colette J, Chera Bhisham
Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
Pract Radiat Oncol. 2024 Jul-Aug;14(4):328-333. doi: 10.1016/j.prro.2024.04.003. Epub 2024 Apr 16.
Delineation of the clinical target volume (CTV) after resection of head and neck cancer can be challenging, especially after flap reconstruction. The main area of contention is whether the entire flap should be included in the CTV. Several case series have reported marginal misses and intraflap failures when the entire flap was not routinely included in the CTV. On the other hand, available data have not convincingly demonstrated a detriment to long-term outcomes using intensity modulated radiotherapy after flap reconstruction. On the contrary, postoperative radiation can facilitate epilation and mucosalization of the flap tissue, reduce flap bulk, and improve long-term esthetic and functional outcomes. Therefore, our standard practice is to include the entire flap in the CTV. In certain scenarios, we may allow for a lower dose to part of flap distant from the resection bed than the flap-tumor bed junction, where recurrences are most likely. We provide three case vignettes describing such scenarios where sparing part of the flap, and more importantly, the nearby uninvolved native tissue, from high-dose radiation may be justified.
对头颈部癌切除术后临床靶区（CTV）的勾画可能具有挑战性，尤其是在皮瓣重建后。主要的争议点在于CTV是否应包括整个皮瓣。多个病例系列报告称，当CTV未常规包括整个皮瓣时，会出现边缘遗漏和皮瓣内复发。另一方面，现有数据并未令人信服地证明皮瓣重建后使用调强放疗会对长期预后产生不利影响。相反，术后放疗可促进皮瓣组织的脱毛和黏膜化，减少皮瓣体积，并改善长期的美观和功能预后。因此，我们的标准做法是将整个皮瓣纳入CTV。在某些情况下，对于远离切除床的皮瓣部分，我们可能会给予比皮瓣-肿瘤床交界处更低的剂量，因为后者最有可能复发。我们提供了三个病例 vignettes，描述了在这些情况下， sparing部分皮瓣，更重要的是， sparing附近未受累的原生组织免受高剂量辐射可能是合理的。
