Changing failure patterns in oropharyngeal squamous cell carcinoma treated with intensity modulated radiotherapy and implications for future research
Changing failure patterns in oropharyngeal squamous cell carcinoma treated with intensity modulated radiotherapy and implications for future research
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DOI：
10.1097/01.coc.0000242294.89536.d6
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发表时间：
2006-12-01
影响因子：
2.6
通讯作者：
Hoffman, Henry T.
中科院分区：
文献类型：
--
作者：
Yao, Min;Nguyen, Thanh;Hoffman, Henry T.
目的：回顾爱荷华大学口咽癌调强放射治疗(IMRT)的经验。方法：2000年1月至2004年7月，66例口咽癌患者接受调强放疗，62例单纯调强放疗，4例术后调强放疗。定义了三个目标卷(CTV1、CTV2和CTV3)。CTV1、CTV2和CTV3的剂量分别为70~74、60、54和60~66、60、54个月。结果：中位随访期为27.3个月，所有患者的随访期至少为11.5个月。局部区域无进展生存率的3年估计为98.8%。然而，远处转移的发生率很高，3年无远处转移生存率估计为80.4%。此外，第二原发癌的发病率也很高。3年总生存率为78.1%，3年无瘤生存率为64.4%。治疗耐受性良好，1例死于治疗毒性。结论：调强放射治疗为口咽癌患者提供了良好的局部控制。随着远处失败患者比例的增加，失败模式发生了变化，无论是转移还是第二原发肿瘤。因此，这些患者的存活率仍然很低。未来的研究应侧重于识别远距离疾病的高危患者，并开发对远距离疾病的有效系统治疗和预防。
Objective: Review the University of Iowa experience with intensity modulated radiation treatment (IMRT) in oropharyngeal squamous cell carcinoma.Methods: From January 2000 to July 2004, 66 patients with oropharyngeal cancer were treated with IMRT, 62 with definitive IMRT and 4 postoperative IMRT. Three target volumes (CTV1, CTV2, and CTV3) were defined. The prescribed doses to CTV1, CTV2, and CTV3 were 70 to 74 Gy, 60 Gy, and 54 Gy, respectively, for definitive IMRT, and 60 to 66 Gy, 60 Gy, and 54 Gy, respectively, for postoperative IMRT.Results: Median follow-up was 27.3 months and all living patients had a follow-up of at least 11.5 months. The 3-year estimate of locoregional progression free survival was 98.8%. However, there is a high incidence of distant metastasis with a 3-year estimate of distant metastasis-free survival of 80.4%. In addition, there is a high incidence of second primary tumor. The 3-year overall survival and 3-year disease-free survival were 78.1% and 64.4%, respectively. Treatment was well tolerated with 1 death resulting from treatment toxicity.Conclusions: IMRT offers an excellent locoregional control for oropharyngeal cancer patients. Failure patterns have changed with an increased portion of patients who failed distantly, either with metastasis or second primary tumor. Therefore, survival for these patients is still poor. Future research should focus on identifying patients at high risk of distant diseases and developing effective systemic treatment and prevention for distant diseases.