Intensity-modulated radiation therapy for oropharyngeal carcinoma: Impact of tumor volume
Intensity-modulated radiation therapy for oropharyngeal carcinoma: Impact of tumor volume
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DOI：
10.1016/j.ijrobp.2003.08.004
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发表时间：
2004-05-01
影响因子：
7
通讯作者：
Sessions, DG
中科院分区：
文献类型：
--
作者：
Chao, KSC;Ozyigit, G;Sessions, DG
目的：评估口咽癌患者接受调强放射治疗（IMRT）的治疗结果，并分析原发性肉眼肿瘤体积（GTV）和淋巴结GTV（nGTV）对生存率和局部控制率的影响。 方法和材料：1997年2月至2001年9月，74例口咽鳞状细胞癌患者接受了IMRT治疗。 31 名患者接受了明确的 IMRT； 17 人还接受了铂类化疗。 43 名患者接受了联合手术和术后 IMRT。所有患者的中位随访时间为 33 个月（范围：9-60 个月）。 52 名患者 (70.3%) 患有 IV 期疾病，17 名患者 (23%) 患有 III 期，3 名患者 (4.1%) 患有 II 期，2 名患者 (2.7%) 患有 I 期肿瘤。最终组和术后组的平均处方剂量分别为 70 和 66 Gy。每日分次剂量为 1.9 或 2 Gy，每周 5 次。 GTV 和/或 nGTV 是使用放射治疗研究计算环境（华盛顿大学开发的免费软件包）确定和导出的。平均 GTV 为 30.5 +/- 22.3 cm(3)，平均 nGTV 为 23.2 +/- 20.6 cm(3)。 结果：观察到 10 个局部区域失败。六名患者死于疾病，三名患者死于并发疾病。 6 名患者出现远处转移。 4 年总生存率估计为 87%，4 年无病生存率估计为 81%（最终组为 66%，术后 RT 组为 92%）。 4 年局部区域控制估计为 87%（最终组为 78%，术后 RT 组为 95%）； 4 年无远处转移生存率估计为 90%（最终组为 84%，术后组为 94%）。多变量分析显示，GTV 和 nGTV 是决定口咽部 IMRT 患者局部控制和无病生存的独立危险因素。记录的最严重的晚期毒性如下： 32 名 1 级和 9 级患者患有 2 级口干症； 2级1级和1级2级皮肤毒性； 3 患有1级晚期粘膜炎； 3 例患有 1 级牙关紧闭。 17例患者需要放置胃造口管。结论：IMRT是局部晚期口咽癌的有效治疗方式。 GTV 和 nGTV 是预测治疗结果的最重要因素。 (C) 2004 年爱思唯尔公司。
Purpose: To assess the therapeutic outcomes in oropharyngeal cancer patients treated with intensity-modulated radiotherapy (IMRT) and analyze the impact of primary gross tumor volume (GTV) and nodal GTV (nGTV) on survival and locoregional control rates.Methods and Materials: Between February 1997 and September 2001, 74 patients with squamous cell carcinoma of the oropharynx were treated with IMRT. Thirty-one patients received definitive IMRT; 17 also received platinum-based chemotherapy. Forty-three patients received combined surgery and postoperative IMRT. The median follow-up for all patients was 33 months (range, 9-60 months). Fifty-two patients (70.3%) had Stage IV disease, 17 patients (23%) had Stage III, 3 patients (4.1%) had Stage II, and 2 patients (2.7%) had Stage I tumors. The mean prescription dose was 70 and 66 Gy, respectively, for the definitive and postoperative cohorts. The daily fraction dose was either 1.9 or 2 Gy, five times weekly. The GTV and/or nGTV were determined and derived using the Computational Environment for Radiotherapy Research, a free software package developed at Washington University. The mean GTV was 30.5 +/- 22.3 cm(3), and the mean nGTV was 23.2 +/- 20.6 cm(3).Results: Ten locoregional failures were observed. Six patients died of disease and three died of concurrent disease. Distant metastasis developed in 6 patients. The 4-year estimate of overall survival was 87%, and the 4-year estimate of disease-free survival was 81% (66% in the definitive vs. 92% in the postoperative RT group). The 4-year estimate of locoregional control was 87% (78% in the definitive vs. 95% in the postoperative RT group); the 4-year estimate of distant metastasis-free survival was 90% (84% in the definitive vs. 94% in the postoperative group). Multivariate analysis showed that GTV and nGTV were independent risk factors determining locoregional control and disease-free survival for definitive oropharyngeal IMRT patients. The worst late toxicities documented were as follows: 32 patients with Grade 1 and 9 with Grade 2 xerostomia; 2 with Grade 1 and 1 with Grade 2 skin toxicity; 3 with Grade 1 late mucositis; and 3 with Grade 1 trismus. Seventeen patients required gastrostomy tube placement.Conclusion: IMRT is an effective treatment modality for locally advanced oropharyngeal carcinoma. The GTV and nGTV are the most important factors predictive of therapeutic outcome. (C) 2004 Elsevier Inc.