Complications following re-irradiation for head and neck cancer
Complications following re-irradiation for head and neck cancer
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DOI：
10.1053/ajot.2002.124540
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发表时间：
2002-07-01
影响因子：
2.5
通讯作者：
Akiba, T
中科院分区：
文献类型：
--
作者：
Ohizumi, Y;Tamai, Y;Akiba, T
目的：由于先前照射区域的剂量过量，再次照射可能会引起严重的并发症。确实有一些报告描述了晚期并发症的发生率和相关因素。在本研究中，我们分析了头颈癌再照射后的并发症。材料和方法：1984年至1998年间，91名头颈部鳞状细胞癌患者接受了总剂量80-144 Gy和4-128 cm(2)重叠野的再照射。再次照射仅采用常规（n = 47）、超分割（n = 10）或大分割（n = 34）的外照射。化疗与初始放疗（n = 34）或再次放疗（n = 18）相结合。随访时间3～84个月。结果：6.6%的患者出现严重急性反应。此外，80岁以上的老年患者的发病率显着更高（40%）。再次照射后 3-10 个月出现严重的晚期并发症。在 78 名随访超过 3 个月的患者中，发生率为 13%；在 42 名无肿瘤状态患者中，发生率为 21%。与仅接受局部照射的患者（0%）相比，先前接受局部照射的患者中有 19% 出现并发症；与接受头部再照射的患者（3%）相比，接受颈部再照射的患者有 20% 出现并发症。通过多变量分析，这些因素都很重要。放射剂量、分割方法和重叠面积均不显着。结论：应注意老年患者发生急性并发症的可能性，以及先前接受过颈部局部照射和再次照射的患者发生晚期并发症的可能性。版权所有2002，Elsevier Science（美国）。版权所有。
Purpose: Re-irradiation may induce serious complications because of overdosage to previously irradiated areas. A few reports do exist that describe the incidence and factors related to late complications. In the present study we analyze complications following re-irradiation for head and neck cancers.Materials and Methods: Between 1984 and 1998, 91 patients presenting with squamous cell carcinoma of the head and neck were re-irradiated with a total dose of 80-144 Gy and overlap fields of 4-128 cm(2). Re-irradiation was administered exclusively with external beam irradiation with conventional (n = 47), hyper- (n = 10), or hypofractionation (n = 34). Chemotherapy was combined with the initial course of irradiation (n = 34) or re-irradiation (n = 18). Follow-up time ranged from 3 to 84 months.Results: Severe acute reactions occurred in 6.6% of patients. Moreover, incidence was significantly higher (40%) in elderly patients older than 80 years. Severe late complications developed 3-10 months after re-irradiation. The incidence was 13% in 78 patients followed for more than 3 months and 21% in 42 patients with tumor-free status. The complications were observed in 19% of patients previously receiving locoregional irradiation, compared with those receiving local irradiation alone (0%), and in 20% of patients undergoing re-irradiation to the neck, compared with those receiving re-irradiation to the head (3%). These factors were all significant by multivariate analysis. Radiation dose, fractionation method, and overlap area were not significant.Conclusion: Care should be exercised with respect to the potential for acute complications in elderly patients and late complications in those patients having previously received locoregional irradiation and re-irradiation to the neck. Copyright 2002, Elsevier Science (USA). All rights reserved.