Adaptive radiotherapy for head-and-neck cancer: initial clinical outcomes from a prospective trial.
Adaptive radiotherapy for head-and-neck cancer: initial clinical outcomes from a prospective trial.
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DOI：
10.1016/j.ijrobp.2011.08.017
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发表时间：
2012-07-01
影响因子：
7
通讯作者：
Dong, Lei
中科院分区：
文献类型：
--
作者：
Schwartz, David L.;Garden, Adam S.;Thomas, Jimmy;Chen, Yipei;Zhang, Yongbin;Lewin, Jan;Chambers, Mark S.;Dong, Lei
介绍一项研究口咽鳞状细胞癌适应性放疗（ART）的前瞻性试验的初步毒性和生存结局。24例患者入组IRB批准的临床试验。分析了22例患者。每日CT引导设置和可变形图像配准允许连续标测CTV和避免ART计划的结构。原发部位舌根15例，扁桃体6例，舌咽沟1例。20例（91%）患者患有AJCC IV期疾病。T阶段分布为2 T1、12 T2、3 T3、5 T4; N阶段分布为1 N 0、2 N1、5 N2 a、12 N2 b、2 N2 c。21例（95%）患者接受了全身治疗。中位随访31个月（范围：13-45），无原发部位失败和1例淋巴结复发，2年时局部疾病控制率为100%，区域疾病控制率为95%。基线肿瘤大小与绝对体积治疗反应相关（p = 0.018）。腮腺体积变化与饲管放置时间相关（p = 0.025）。急性毒性与常规IMRT结果相当。对1年后的慢性毒性和功能结局进行制表。这是第一次对局部晚期头颈癌患者接受自动适应性重新计划治疗的发病率和生存结局进行前瞻性评估。ART仅需1或2次治疗中期重新计划事件即可提供剂量学获益。我们的初步临床结果记录了功能恢复和疾病控制的保存在一年随访及以后。
To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma. Twenty-four patients enrolled onto an IRB-approved clinical trial. Twenty-two patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of CTVs and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6, and glossopharyngeal sulcus in 1. Twenty (91%) patients had AJCC stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4 and N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Twenty-one (95%) patients received systemic therapy. With 31 month median follow up (range: 13-45), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to conventional IMRT results. Chronic toxicity and functional outcomes beyond 1 year were tabulated. This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head and neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only 1 or 2 mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at one-year follow-up and beyond.
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期刊：
International journal of radiation oncology, biology, physics
影响因子：
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