Zhou Xiong, Wu Zheng, Qiu Zichen, Lin Minchuan, Tao Yalan, Su Yong
Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China.
Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China.
Head Neck. 2025 Apr;47(4):1247-1255. doi: 10.1002/hed.28037. Epub 2024 Dec 18.
In this study, we aimed to analyze the efficacy and failure patterns of contouring target volume based on the residual tumor and decreasing the dose to the area of tumor regression after neoadjuvant therapy in locoregionally advanced head and neck squamous cell carcinoma (HNSCC).
We retrospectively analyzed the patients with locoregionally advanced HNSCC treated by our group from May 2011 to June 2023. All patients received neoadjuvant therapy followed by intensity-modulated radiation therapy. Gross tumor volumes for the primary tumor and metastatic lymph nodes were delineated according to postneoadjuvant extension. The tumor shrinkage after neoadjuvant therapy was included in the high-risk clinical target volume (CTV1) and prescribed a dose of 60 Gy. Kaplan-Meier analysis was employed to calculate local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), overall survival (OS), and distant metastasis-free survival (DMFS). Failure patterns were analyzed by mapping the location and extent of locoregional recurrence onto pretreatment planning CT.
This study included a total of 114 patients, with a median follow-up of 34 months. The 5-year LRFS, RRFS, OS, and DMFS rates were 70.2%, 70.7%, 74.8%, and 73.8%, respectively. Among the 14 patients with recurrences, there were 5 local failures, 6 regional recurrences, and 3 both local and regional recurrences. All local recurrences occurred within the 95% isodose line, classified as in-field failures. Only one regional recurrence was marginal failure. No out-of-field failure was observed.
Reduction of target volume after neoadjuvant therapy and distribution of 60 Gy of dose to the tumor regression area may be feasible.
在本研究中，我们旨在分析基于残留肿瘤勾画靶区体积以及在局部晚期头颈部鳞状细胞癌（HNSCC）新辅助治疗后降低肿瘤退缩区域剂量的疗效和失败模式。
我们回顾性分析了2011年5月至2023年6月期间由我们团队治疗的局部晚期HNSCC患者。所有患者均接受新辅助治疗，随后进行调强放射治疗。根据新辅助治疗后的范围勾画原发肿瘤和转移淋巴结的大体肿瘤体积。新辅助治疗后肿瘤缩小部分纳入高危临床靶区（CTV1），并给予60 Gy的剂量。采用Kaplan-Meier分析计算局部无复发生存率（LRFS）、区域无复发生存率（RRFS）、总生存率（OS）和远处无转移生存率（DMFS）。通过将局部区域复发的位置和范围映射到治疗前计划CT上来分析失败模式。
本研究共纳入114例患者，中位随访时间为34个月。5年LRFS、RRFS、OS和DMFS率分别为70.2%、70.7%、74.8%和73.8%。在14例复发患者中，有5例局部复发、6例区域复发和3例局部及区域均复发。所有局部复发均发生在95%等剂量线内，归类为野内失败。只有1例区域复发为边缘性失败。未观察到野外失败。
新辅助治疗后缩小靶区体积并将60 Gy剂量分布到肿瘤退缩区域可能是可行的。
