Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: An RTOG analysis
Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: An RTOG analysis
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DOI：
10.1200/jco.2007.14.8841
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发表时间：
2008-07-20
影响因子：
45.3
通讯作者：
Ang, K. Kian
中科院分区：
文献类型：
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作者：
Machtay, Mitchell;Moughan, Jennifer;Ang, K. Kian
目的头颈鳞状细胞癌 (SCCHN) 的同步放化疗 (CCRT) 可增强局部肿瘤控制和毒性。本研究评估了与 CCRT 后严重晚期毒性相关并可能预测严重晚期毒性的临床因素。方法对患者进行了分析，其中包括先前报道的三项放射治疗肿瘤学组 (RTOG) 局部晚期 SCCHN CCRT 试验（RTOG 91-11、97-03 和 99-14）。在此二次分析中，严重晚期毒性被定义为慢性 3 至 4 级咽/喉毒性（RTOG/欧洲癌症研究和治疗组织晚期毒性评分系统）和/或注册后 2 年以上需要饲管和/或 3 年内潜在的治疗相关死亡（例如肺炎）。采用多变量逻辑回归模型进行病例对照分析，其中包括治疗前和治疗潜在因素。结果共有 230 名患者可用于该分析：99 名患有严重晚期毒性的患者和 131 名对照患者；因此，43% 的可评估患者出现严重的晚期毒性。在多变量分析中，与严重晚期毒性的发生相关的显着变量是年龄较大（比值比每年 1.05；P=0.001）；晚期 T 期（优势比，3.07；P=.0036）；喉/下咽原发部位（比值比，4.17；P=.0041）； CRT 后进行颈清扫术（比值比，2.39；P=.018）。结论 CCRT 后严重的晚期毒性很常见。年龄较大、T 期晚期和喉/下咽原发部位是很强的独立危险因素。 CCRT 后的颈清扫术与这些并发症的风险增加相关。
PurposeConcurrent chemoradiotherapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases both local tumor control and toxicity. This study evaluates clinical factors that are associated with and might predict severe late toxicity after CCRT.MethodsPatients were analyzed from a subset of three previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3 to 4 pharyngeal/laryngeal toxicity (RTOG/European Organisation for the Research and Treatment of Cancer late toxicity scoring system) and/or requirement for a feeding tube >= 2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Case-control analysis was performed, with a multivariable logistic regression model that included pretreatment and treatment potential factors.ResultsA total of 230 patients were assessable for this analysis: 99 patients with severe late toxicities and 131 controls; thus, 43% of assessable patients had a severe late toxicity. On multivariable analysis, significant variables correlated with the development of severe late toxicity were older age (odds ratio 1.05 per year; P=.001); advanced T stage (odds ratio, 3.07; P=.0036); larynx/hypopharynx primary site (odds ratio, 4.17; P=.0041); and neck dissection after CRT (odds ratio, 2.39; P=.018).ConclusionSevere late toxicity after CCRT is common. Older age, advanced T-stage, and larynx/hypopharynx primary site were strong independent risk factors. Neck dissection after CCRT was associated with an increased risk of these complications.