Nanda Sambit S, Kapoor Ankita Rungta, Mukherji Ashutosh, Choubey Ajay Kumar, Kapoor Akhil, Krishnan Ajay S, Patil Ninad H, Mishra Aseem, Pradhan Satyajit
Department of Radiation Oncology, Homi Bhabha Cancer Hospital & Mahamana Pandit Madanmohan Malaviya Cancer Centre, Tata Memorial Centre, Homi Bhabha National Institute, Varanasi, India.
Department of Medical Oncology, Homi Bhabha Cancer Hospital & Mahamana Pandit Madanmohan Malaviya Cancer Centre, Tata Memorial Centre, Homi Bhabha National Institute, Varanasi, India.
Sci Rep. 2025 May 28;15(1):18721. doi: 10.1038/s41598-025-00557-7.
Advancements in surgical and radiotherapy techniques have enhanced locoregional control (LRC) in head and neck squamous cell carcinoma (HNSCC), yet 30-40% of patients still experience recurrence within 2-3 years. Salvage surgery can result in significant morbidity and often fails to achieve optimal LRC as a standalone treatment. Modern radiotherapy (RT) techniques support highly conformal re-irradiation for small local recurrences with acceptable toxicity. The role of positron emission tomography (PET-CT) based contouring is under evaluation for re-irradiation settings. This retrospective study included patients treated with re-irradiation at a tertiary care center, focusing on those with prior HNSCC in the oral cavity, pharynx, or larynx, who had received radical or adjuvant RT and presented with biopsy-confirmed recurrences or second primary tumors. PET-CT was used for metastatic workup, with rigid image registration on planning CT scan employing a significant 40% SUVmax cut-off for tumor delineation. From January 2019 to June 2022, 85 patients underwent re-irradiation, with a median RT dose of 60 Gy (range: 44-66 Gy); 32 patients received concurrent chemoradiotherapy (CRT). Treatment planning used the volumetric modulated arc technique (VMAT), with the median Dmax for critical structures ranging from 7 Gy to 63 Gy. Acute grade 3 or higher mucositis, dysphagia, and odynophagia were observed in up to 23.5% of cases. At a median follow-up of 23 months, the 2-year disease-free survival (DFS) and overall survival (OS) rates were 55.2% and 63.5%, respectively. These promising results support PET-CT contouring-based planning as a potential standard of care in re-irradiation.
手术和放疗技术的进步提高了头颈部鳞状细胞癌（HNSCC）的局部区域控制（LRC），然而仍有30%-40%的患者在2-3年内出现复发。挽救性手术可能导致显著的并发症，且作为单一治疗往往无法实现最佳的LRC。现代放疗（RT）技术支持对小的局部复发进行高剂量适形再照射，毒性可接受。基于正电子发射断层扫描（PET-CT）的轮廓勾画在再照射中的作用正在评估中。这项回顾性研究纳入了在三级医疗中心接受再照射治疗的患者，重点关注那些先前患有口腔、咽或喉HNSCC，接受过根治性或辅助性RT且经活检证实有复发或第二原发性肿瘤的患者。PET-CT用于转移灶检查，在计划CT扫描上采用刚性图像配准，使用40%的SUVmax作为肿瘤勾画的显著截断值。2019年1月至2022年6月，85例患者接受了再照射，中位RT剂量为60 Gy（范围：44-66 Gy）；32例患者接受了同步放化疗（CRT）。治疗计划采用容积调强弧形技术（VMAT），关键结构的中位Dmax范围为7 Gy至63 Gy。高达23.5%的病例观察到急性3级或更高等级的黏膜炎、吞咽困难和吞咽痛。中位随访23个月时，2年无病生存率（DFS）和总生存率（OS）分别为55.2%和63.5%。这些有前景的结果支持基于PET-CT轮廓勾画的计划作为再照射中潜在的标准治疗方法。
