Delaney G P, Fisher R J, Smee R I, Hook C, Barton M B
Division of Radiation Oncology, Westmead Hospital, NSW, Australia.
Int J Radiat Oncol Biol Phys. 1995 Jun 15;32(3):763-8. doi: 10.1016/0360-3016(95)00093-E.
To retrospectively assess a protocol of split-course accelerated radiation therapy (SCAT) for selected head and neck cancers.
SCAT consisted of 1.8 Gy per fraction administered twice daily with a minimum gap between fractions of 6 h. The treatment protocol prescribed an initial 16 fractions followed by a planned 5 to 12 day break, and then a further 20 to 22 fractions for a total dose ranging from 64.8 to 72 Gy delivered in 5 to 6 weeks.
Twenty-eight patients received SCAT for histologically confirmed head and neck cancer between January 1987 and August 1991. All patients were followed up until December 1, 1993. The mean potential follow-up time was 4.2 years (range: 2.9-6.2 years). All patients completed the treatment protocol. Thirteen tumors were laryngeal in origin, eight hypopharyngeal, four paranasal sinus, and three oropharyngeal. There were no Stage I, three Stage II, nine Stage III, and 12 Stage IV tumors. Four tumors were not staged (two paranasal sinus cancers and two surgical recurrences). Early and late toxicities were moderate to severe. Confluent mucositis was experienced by 27 of the 28 patients (96%). One patient required a prolonged midtreatment break of 24 days. Nine patients (32%) required narcotic analgesia for pain relief. Eleven patients (39%) required hospitalization for nasogastric feeding or pain control. The median length of hospital stay was 14 days (range 7-98 days). The actuarial rate of severe late toxicity at 3 years was 47% (standard error (SE) = 13%). A complete tumor response was achieved in 86% of patients. The actuarial local control rate at 3 years was 43% (SE = 11%) and the actuarial survival rate at 3 years was 25% (SE = 8%).
Given the encouraging complete response rate and local control for such advanced tumors, SCAT for locoregionally advanced tumors merits further investigation. However, because of the significant late toxicity observed, the total dose, interfraction interval, and fractionation technique used should be reconsidered.
回顾性评估针对特定头颈癌的分段加速放射治疗（SCAT）方案。
SCAT方案为每次分割剂量1.8 Gy，每日照射两次，分割之间的间隔至少6小时。治疗方案规定先进行16次分割照射，之后计划休息5至12天，然后再进行20至22次分割照射，总剂量在64.8至72 Gy之间，于5至6周内完成。
1987年1月至1991年8月期间，28例经组织学确诊的头颈癌患者接受了SCAT治疗。所有患者均随访至1993年12月1日。平均潜在随访时间为4.2年（范围：2.9 - 6.2年）。所有患者均完成了治疗方案。13例肿瘤原发于喉部，8例原发于下咽，4例原发于鼻窦，3例原发于口咽。无Ⅰ期肿瘤，3例Ⅱ期肿瘤，9例Ⅲ期肿瘤，12例Ⅳ期肿瘤。4例肿瘤未分期（2例鼻窦癌和2例手术复发癌）。早、晚期毒性反应为中度至重度。28例患者中有27例（96%）发生了融合性黏膜炎。1例患者在治疗中期需要延长24天的休息时间。9例患者（32%）需要使用麻醉性镇痛药缓解疼痛。11例患者（39%）因鼻饲或控制疼痛需要住院治疗。中位住院时间为14天（范围7 - 98天）。3年时严重晚期毒性反应的精算发生率为47%（标准误（SE）= 13%）。86%的患者实现了肿瘤完全缓解。3年时的精算局部控制率为43%（SE = 11%），3年时的精算生存率为25%（SE = 8%）。
鉴于对于此类晚期肿瘤令人鼓舞的完全缓解率和局部控制效果，针对局部区域晚期肿瘤的SCAT值得进一步研究。然而，由于观察到显著的晚期毒性反应，应重新考虑所使用的总剂量、分割间隔和分割技术。
