Jaulerry C, Dubray B, Brunin F, Rodriguez J, Point D, Blaszka B, Asselain B, Mosseri V, Brugere J, Cosset J M
Department of Radiotherapy, Institut Curie, Paris, France.
Int J Radiat Oncol Biol Phys. 1995 Sep 30;33(2):271-9. doi: 10.1016/0360-3016(95)00157-T.
Prospective evaluation of tumor regression during external irradiation for head and neck squamous cell carcinomas and its association with long-term local control.
Two hundred twenty-eight patients with histologically confirmed squamous cell carcinoma [oral cavity: 59 (26%), oropharynx: 65 (29%), hypopharynx: 37 (16%), larynx: 67 (29%)] were included between January 1986 and December 1990. Curative intent external irradiation delivered 65-70 Gy over a period of 7 weeks (five 2 Gy fractions per week). Tumor regression was evaluated clinically and endoscopically every week.
Tumor regression, assessed at 2 weeks, was as follows: no response: 62 (30%), 25% response: 121 (59%); 50% response: 23 (11%). At 5 weeks, 9 (4%) patients showed 0-25% regression, 75 (33%) showed 50% regression, 115 (50%) showed 75% regression, and 29 (13%) showed complete regression. Median follow-up was 79 months (range: 6-96 months). The local control probability was 68% (62-74%) at 2 years, 65% (59-70%) at 5 years. Univariate analysis showed that, at 2 weeks, local control was significantly different between the nonresponders and the patients with 25% or greater response (p < 0.025) and that, at the fifth week, local control was very different between the major responders (75 and 100%) and the minor responders (0-50%) (p < 0.0001). Multivariate analysis (Cox Proportional Hazards Model) showed that the probability of local relapse was significantly and independently increased for minor regression at 5 weeks [Relative risk (RR) of failure was 2.3 (1.4-3.7)], for nonlaryngeal tumors [RR: 2.4 (1.3-4.5)], and for Stage T3-T4 [RR:2.4 (1.4-4)]. Three prognostic groups can, therefore, be proposed: 1) low risk of recurrence when regression > or = 75% and laryngeal tumor or T1-T2 tumors in other sites: 106 (46.5%) patients, 2-year local control probability: 84% (77-92%); 2) high risk of recurrence: regression < or = 50% and T3-T4 nonlaryngeal tumors: 44 (19%) patients, 2-year local control probability: 27% (13-41%); 3) intermediate risk of recurrence: 78 (34.5%) patients, 2-year local control probability: 69% (58-80%).
The present study suggests that tumor regression during external radiotherapy is an independent predictive factor of local control in head and neck carcinomas.
对头颈部鳞状细胞癌外照射期间的肿瘤消退情况进行前瞻性评估，并探讨其与长期局部控制的相关性。
1986年1月至1990年12月期间纳入了228例经组织学确诊的鳞状细胞癌患者[口腔：59例（26%），口咽：65例（29%），下咽：37例（16%），喉：67例（29%）]。根治性外照射在7周内给予65 - 70 Gy（每周5次，每次2 Gy）。每周通过临床和内镜评估肿瘤消退情况。
在2周时评估的肿瘤消退情况如下：无反应：62例（30%），25%反应：121例（59%）；50%反应：23例（11%）。在5周时，9例（4%）患者显示0 - 25%消退，75例（33%）显示50%消退，115例（50%）显示75%消退，29例（13%）显示完全消退。中位随访时间为79个月（范围：6 - 96个月）。2年时局部控制概率为68%（62 - 74%），5年时为65%（59 - 70%）。单因素分析显示，在2周时，无反应者与有25%或更大反应的患者之间局部控制有显著差异（p < 0.025），在第5周时，主要反应者（75%和100%）与次要反应者（0 - 50%）之间局部控制差异非常显著（p < 0.0001）。多因素分析（Cox比例风险模型）显示，5周时轻度消退[失败的相对风险（RR）为2.3（1.4 - 3.7）]、非喉肿瘤[RR：2.4（1.3 - 4.5）]以及T3 - T4期[RR：2.4（1.4 - 4）]时局部复发的概率显著且独立增加。因此，可以提出三个预后组：1）当消退≥75%且为喉肿瘤或其他部位的T1 - T2肿瘤时复发风险低：106例（46.5%）患者，2年局部控制概率：84%（77 - 92%）；2）复发风险高：消退≤50%且为T3 - T4非喉肿瘤：44例（19%）患者，2年局部控制概率：27%（13 - 41%）；3）复发风险中等：78例（34.5%）患者，2年局部控制概率：69%（58 - 80%）。
本研究表明，外照射期间的肿瘤消退是头颈部癌局部控制的独立预测因素。
