Horiot J C, Bontemps P, van den Bogaert W, Le Fur R, van den Weijngaert D, Bolla M, Bernier J, Lusinchi A, Stuschke M, Lopez-Torrecilla J, Begg A C, Pierart M, Collette L
Department of Radiotherapy, Tumour Institute Centre Georges Francois Leclerc, Dijon, France.
Radiother Oncol. 1997 Aug;44(2):111-21. doi: 10.1016/s0167-8140(97)00079-0.
A 5 week-hyperfractionated and accelerated radiotherapy regimen without reduction of the total dose was developed to fight tumour repopulation during treatment and tumour hypoxia. The purpose of the study was to try to improve loco-regional control in high risk head and neck carcinoma treated with curative radiotherapy.
From 1985 to 1995, a randomised controlled trial of the EORTC Cooperative Group of Radiotherapy (EORTC 22851) compared the experimental regimen (72 Gy/45 fractions/5 weeks) to standard fractionation and overall treatment time (70 Gy/35 fractions/7 weeks) in T2, T3 and T4 head and neck cancers (hypopharynx excluded). The end-point criteria were local and loco-regional control, overall and disease-free survival, and acute and late toxicities. Five hundred twelve patients were accrued.
Patients in the AF (accelerated fractionation) arm did significantly better with regard to loco-regional control (P = 0.02) resulting at 5 years in a 13% gain (95% CI 3-23% gain) in loco-regional control over the CF (conventional fractionation) arm. This improvement is of larger magnitude in patients with poorer prognosis (N2-3 any T, T4 any N) than in patients with more favourable stage. Multivariate analysis confirmed AF as an independent prognostic factor of good prognosis for loco-regional control (P = 0.03). Specific survival shows a trend (P = 0.06) in favour of the AF arm. ACUTE AND LATE TOXICITIES: Acute and late toxicity were increased in the AF arm. Late severe functional irradiation damage occurred in 14% of patients of the AF arm versus 4% in the CF arm. Two cases of radiation-induced myelitis occurred after doses of 42 and 48 Gy to the spinal cord.
This trial shows that accelerated radiotherapy improves loco-regional control in head and neck squamous cell carcinomas. A less toxic scheme should, however, be investigated and documented before using accelerated radiotherapy as a standard regimen of curative radiotherapy for head and neck cancers.
为应对治疗期间肿瘤再增殖及肿瘤缺氧问题，制定了一种为期5周的超分割加速放疗方案，且不降低总剂量。本研究旨在尝试改善接受根治性放疗的高危头颈癌的局部区域控制情况。
1985年至1995年，欧洲癌症研究与治疗组织（EORTC）放射治疗协作组（EORTC 22851）开展了一项随机对照试验，将实验方案（72 Gy/45次分割/5周）与T2、T3和T4期头颈癌（下咽癌除外）的标准分割及总治疗时间（70 Gy/35次分割/7周）进行比较。终点标准为局部及局部区域控制、总生存及无病生存，以及急性和晚期毒性反应。共纳入512例患者。
加速分割（AF）组患者在局部区域控制方面显著更优（P = 0.02），5年时局部区域控制率比常规分割（CF）组提高了13%（95%可信区间为提高3% - 23%）。预后较差的患者（N2 - 3任何T期、T4任何N期）的改善幅度大于分期较好的患者。多因素分析证实AF是局部区域控制良好预后的独立预后因素（P = 0.03）。特定生存情况显示倾向于AF组的趋势（P = 0.06）。急性和晚期毒性反应：AF组的急性和晚期毒性反应增加。AF组14%的患者发生了晚期严重功能放射损伤，而CF组为4%。脊髓接受42 Gy和48 Gy剂量照射后发生了2例放射性脊髓炎。
本试验表明加速放疗可改善头颈鳞状细胞癌的局部区域控制。然而，在将加速放疗作为头颈癌根治性放疗的标准方案使用之前，应研究并记录毒性更低的方案。
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