Kristensen Morten Horsholt, Nielsen Signe Bergliot, Alsner Jan, Holm Anne Ivalu Sander, Hansen Christian Rønn, Overgaard Jens, Eriksen Jesper Grau
Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Oto-Rhino-Laryngology, Head and Neck, Aarhus University Hospital, Denmark.
Radiother Oncol. 2025 Jun;207:110838. doi: 10.1016/j.radonc.2025.110838. Epub 2025 Mar 13.
The prognosis following loco-regional failure after primary radiotherapy (RT) for head and neck squamous cell carcinoma (HNSCC) is poor. The hypothesis that most failures occur as a consequence of tumor radioresistance, can be evaluated by proxy as the proportion of failures that occur in the high-dose region. Several studies have investigated possible reasons for treatment failure by an image-based pattern of failure analyses (POF), comparing the initial planning CT scan with a scan conducted upon failure. The aim of the present systematic review and meta-analysis was to evaluate the proportion of failures that occurred in the high-dose region of all analyzed failures.
A systematic database search from 2000 to 2023, was performed for studies including results from image-based loco-regional POF, regardless of the method, after primary RT for HNSCC. Proportions of volumetrically in-field (opposed to marginal or outfield) failures, point of origin-based inside high-dose targets, or covered by curative doses for both the number of patients and the number of failure sites were analyzed in proportional meta-analyses. The review was registered at Prospero (CRD42023412545).
Out of 56 included studies, accumulated image-based POF results were available from 1,161 patients and 658 individual failure sites. The majority of patients had in-field failures in volumetric-based studies (84 % (95 % CI: 77;90)), inside failures in point of origin-based studies (82 % (95% CI:61;85)) or failures covered by 95 % of dose prescribed to CTV1 (84 % (95% CI:69;95)). A trend toward increasing proportions of non-high-dose failures in more recently treated patients was observed.
Most loco-regional failures for patients treated with primary RT for HNSCC are related to the high-dose volume. Therefore, a focus on biomarkers predicting individual tumor radiosensitivity is warranted to enable individualized treatment intensification to increase loco-regional control.
头颈部鳞状细胞癌（HNSCC）患者接受初次放射治疗（RT）后发生局部区域失败后的预后较差。多数失败是由肿瘤放射抗性导致的这一假说，可通过高剂量区域内发生的失败比例来间接评估。多项研究通过基于图像的失败模式分析（POF）来探究治疗失败的可能原因，即将初始计划CT扫描与失败时进行的扫描相比较。本系统评价和荟萃分析的目的是评估所有分析的失败中发生在高剂量区域的失败比例。
对2000年至2023年的系统数据库进行检索，纳入初次RT治疗HNSCC后基于图像的局部区域POF结果的研究，不限方法。在比例荟萃分析中，分析了按体积计算的野内（相对于边缘或野外）失败、基于起源点的高剂量靶区内或被根治剂量覆盖的患者数量和失败部位数量的比例。该评价已在国际前瞻性系统评价注册库（Prospero）注册（注册号：CRD42023412545）。
在纳入的56项研究中，有1161例患者和658个个体失败部位可获得累积的基于图像的POF结果。在基于体积的研究中，大多数患者发生野内失败（84%（95%CI：77；90）），在基于起源点的研究中发生内部失败（82%（95%CI：61；85）），或被处方给CTV1的95%剂量覆盖的失败（84%（95%CI：69；95））。观察到在近期治疗的患者中，非高剂量失败比例有增加趋势。
接受初次RT治疗的HNSCC患者的多数局部区域失败与高剂量体积有关。因此，有必要关注预测个体肿瘤放射敏感性的生物标志物，以便能够进行个体化的治疗强化，以提高局部区域控制率。
