Importance of overall treatment time for the outcome of radiotherapy of advanced head and neck carcinoma: Dependency on tumor differentiation
Importance of overall treatment time for the outcome of radiotherapy of advanced head and neck carcinoma: Dependency on tumor differentiation
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DOI：
10.1016/s0167-8140(97)01904-x
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发表时间：
1997-04-01
影响因子：
5.7
通讯作者：
Berthelsen, A
中科院分区：
文献类型：
--
作者：
Hansen, O;Overgaard, J;Berthelsen, A
目的：肿瘤细胞在放疗过程中的加速再生被认为是头颈部鳞状细胞癌治疗失败的重要原因。由于肿瘤的异质性，并不是所有的肿瘤都能从以降低总剂量为代价的加速放疗中获益。该分析评估了与治疗时间相关的组织学分化对局部-区域控制的影响。患者和方法：在两个连续的随机对照试验中，共有501例已知组织病理学分级的晚期声门上和咽鳞状细胞癌患者接受计划分疗程（191例）或持续放疗（310例）的治疗，放疗剂量分别为2gy /次，5次/周，剂量为66- 68gy，分别在9.5周或6.5周。结果：总体而言，分疗程和连续治疗的5年局部-区域控制率分别为30%和41% （P = 0.007）。然而，分程治疗的不利影响仅在中度和分化良好的肿瘤中发现，连续和分程治疗后的5年肿瘤控制率分别为38%和21% （P = 0.001）。相比之下，在低分化肿瘤中，44%的连续治疗病例和40%的分疗程治疗病例获得了局部区域控制（P = 0.63）。结论：我们认为去分化可能会导致肿瘤加速再生的能力丧失，整体治疗时间的延长只会导致分化良好至中度肿瘤的局部-区域控制性降低。(C) 1997爱思唯尔科学爱尔兰有限公司
Purpose: Accelerated repopulation of tumor cells during radiotherapy has been suggested as an important cause of treatment failure in squamous cell carcinoma of the head ind neck. Due to tumor heterogeneity, not all tumors may benefit from accelerated radiotherapy at the expense of a lower total dose. This analysis evaluates the impact of histological differentiation on loco-regional control in relation to treatment duration.Patients and methods: A total of 501 patients with advanced supraglottic and pharyngeal squamous cell carcinoma with known histopathological grading were treated with planned split-course (191 patients) or continuous radiotherapy (310 patients) in two consecutive randomized controlled trials, irradiation was given 2 Gy per fraction, 5 fractions per week to a dose of 66-68 Gy in 9.5 or 6.5 weeks, respectively.Results: Overall, split-course and continuous treatment resulted in a 5-year loco-regional control of 30% and 41% (P = 0.007), respectively. However, the detrimental effects of split-course were only found in moderately and well-differentiated tumors, where the 5-year tumor controls were 38% and 21% after continuous and split-course treatment, respectively (P = 0.001). In contrast, in poorly differentiated tumors loco-regional control was obtained in 44% of the cases for continuous and 40% for split-course treatment (P = 0.63).Conclusions: It is suggested that the ability to accelerate repopulation may be lost by dedifferentiation, and that prolongation of the overall treatment time only lead to reduced loco-regional control in well to moderately differentiated tumors. (C) 1997 Elsevier Science Ireland Ltd.