Salvage re-irradiation for recurrent head and neck cancer
Salvage re-irradiation for recurrent head and neck cancer
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DOI：
10.1016/j.ijrobp.2006.12.055
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发表时间：
2007-07-01
影响因子：
7
通讯作者：
Zelefsky, Michael J.
中科院分区：
文献类型：
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作者：
Lee, Nancy;Chan, Kelvin;Zelefsky, Michael J.
目的：回顾性分析复发性头颈部（HN）癌患者再照射（re-RT）在一个单一的医疗center.Methods和材料的治疗结果：从1996年7月至2005年9月，105例复发性HN癌患者进行了re-RT在ouri-institution。纳入的研究中心包括：颈部21例，鼻咽21例，鼻窦18例，口咽16例，口腔9例，喉10例，腮腺6例，下咽4例。中位既往RT剂量为62戈伊。75例患者接受了re-RT化疗（大多数情况下以铂为基础）。中位再RT剂量为59.4戈伊。在74例（70%），re-RT采用调强放射治疗（IMRT）。结果：平均随访35个月，18例患者存活，无疾病证据。2年局部区域无进展生存率（LRPFS）和总生存率分别为42%和37%。接受调强放射治疗的患者与未接受调强放射治疗的患者相比，2年LRPF更好（52% vs. 20%，p < 0.001）。在多变量分析中，非鼻咽和非调强放疗与局部区域（LR）失败的风险增加相关。LR无进展疾病患者的2年总生存率高于LR失败患者（56%vs.21%，p < 0.001）。23%和15%的患者报告了急性和晚期3-4级毒性。在12例患者中观察到严重的3-4级晚期并发症，再RT后中位发展时间为6个月。结论：根据我们的数据，实现LR控制对于改善该患者人群的总生存率至关重要。调强放射治疗的使用预测更好的LR肿瘤控制。未来的积极努力，在最大限度地控制肿瘤复发的设置，包括剂量递增与调强放疗和改善化疗，是必要的。(c)2007年爱思唯尔公司
Purpose: To present a retrospective review of treatment outcomes for recurrent head and neck (HN) cancer patients treated with re-irradiation (re-RT) at a single medical center.Methods and Materials: From July 1996-September 2005, 105 patients with recurrent HN cancer underwent re-RT at ouri-nstitution. Sites included were: the neck (n = 21), nasopharynx (n = 21), paranasal sinus (n = 18), oropharynx (n = 16), oral cavity (it = 9), larynx (n = 10), parotid (n = 6), and hypopharynx (it = 4). The median prior RT dose was 62 Gy. Seventy-five patients received chemotherapy with their re-RT (platinum-based in the majority of cases). The median re-RT dose was 59.4 Gy. In 74 (70%), re-RT utilized intensity-modutated radiation therapy (IMRT).Results: With a median follow-up of 35 months, 18 patients were alive with no evidence of disease. The 2-year loco-regional progression-free survival (LRPFS) and overall survival rates were 42% and 37%, respectively. Patients who underwent IMRT, compared to those who did not, had a better 2-year LRPF (52 % vs. 20 %, p < 0.001). On multivariate analysis, non-nasopharynx and non-IMRT were associated with an increased risk of loco-regional (LR) failure. Patients with LR progression-free disease had better 2-year overall survival vs. those with LR failure (56% vs. 21%,p < 0.001). Acute and late Grade 3-4 toxicities were reported in 23% and 15% of patients. Severe Grade 3-4 late complications were observed in 12 patients, with a median time to development of 6 months after re-RT.Conclusions: Based on our data, achieving LR control is crucial for improved overall survival in this patient population. The use of IMRT predicted better LR tumor control. Future aggressive efforts in maximizing tumor control in the recurrent setting, including dose escalation with IMRT and improved chemotherapy, are warranted. (c) 2007 Elsevier Inc.