Recurrence in region of spared parotid gland after definitive intensity-modulated radiotherapy for head and neck cancer
Recurrence in region of spared parotid gland after definitive intensity-modulated radiotherapy for head and neck cancer
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DOI：
10.1016/j.ijrobp.2007.09.018
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发表时间：
2008-03-01
影响因子：
7
通讯作者：
Lee, Nancy Y.
中科院分区：
文献类型：
--
作者：
Cannon, Donald M.;Lee, Nancy Y.
目的：探讨头颈癌（HNC）明确调强放疗（IMRT）后腮腺周围复发的三个例子的意义。方法和材料：我们报告了3例HNC患者，他们接受了明确的IMRT并同时进行化疗，后来在腮腺或其附近治疗失败。2例患者有双侧多级别淋巴结疾病，复发部位同侧均有II级淋巴结疾病。患者采用剂量涂绘IMRT治疗，总肿瘤体积剂量为70 Gy，临床高风险或低风险肿瘤体积剂量分别为59.4 Gy或54 Gy。双侧腮腺不受影响。患者放疗前未接受任何手术治疗。结果：所有患者均在腮腺部分治疗失败。2例双侧多节位受累患者的手术失败发生在腮腺周围淋巴结。第三例患者在未受影响的腮腺尾部附近发生皮肤转移。在前处理成像中，2例淋巴结衰竭患者有小的非特异性腮腺周围结节，正电子发射断层扫描显示没有高代谢活动。结论：对于接受终末期IMRT的HNC患者，前处理影像学上非特异性正电子发射断层扫描阴性的腮腺周围结节存在多级别或II级淋巴结转移时，应提高对亚临床疾病的怀疑指数。在保留同侧腮腺之前，可能需要对此类结节进行额外的评估。(c) 2008爱思唯尔公司
Purpose: To discuss the implications of three examples of periparotid recurrence after definitive intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC).Methods and Materials: We present 3 patients with HNC who underwent definitive IMRT with concurrent chemotherapy and later had treatment failure in or near a spared parotid gland. Two patients had bilateral multilevel nodal disease, and all had Level II nodal disease ipsilateral to the site of recurrence. The patients were treated using dose-painting IMRT with a dose of 70 Gy to the gross tumor volume and 59.4 Gy or 54 Gy to the high-risk or low-risk clinical tumor volume, respectively. The parotid glands were spared bilaterally. The patients had not undergone any surgical treatment for HNC before radiotherapy.Results: All patients had treatment failure in the region of a spared parotid gland. Failure in the 2 patients with bilateral multilevel nodal involvement occurred in the periparotid lymph nodes. The third patient developed a dermal metastasis near the tail of a spared parotid gland. On pretreatment imaging, the 2 patients with nodal failure had small nonspecific periparotid nodules that showed no hypermetabolic activity on positron emission tomography.Conclusion: For HNC patients receiving definitive IMRT, nonspecific positron emission tomography-negative periparotid nodules on pretreatment imaging should raise the index of suspicion for subclinical disease in the presence of multilevel or Level II nodal metastases. Additional evaluation of such nodules might be indicated before sparing the ipsilateral parotid gland. (c) 2008 Elsevier Inc.