A Comparison of Outcomes Using Intensity-Modulated Radiation Therapy and 3-Dimensional Conformal Radiation Therapy in Treatment of Oropharyngeal Cancer
A Comparison of Outcomes Using Intensity-Modulated Radiation Therapy and 3-Dimensional Conformal Radiation Therapy in Treatment of Oropharyngeal Cancer
复制标题
DOI：
10.1001/jamaoto.2013.6777
复制
发表时间：
2014-04-01
影响因子：
7.8
通讯作者：
Day, Terry A.
中科院分区：
文献类型：
--
作者：
Lohia, Shivangi;Rajapurkar, Mayuri;Day, Terry A.
重要性大约50%的头颈部癌症幸存者经历吞咽困难和相关的发病率。调强放射治疗(IMRT)越来越多地被用于口咽癌的治疗，获得了良好的肿瘤学结果，但很少有研究将其与传统的三维适形放射治疗(3D-CRT)进行比较，以确定它是否可以减少治疗相关的毒副作用。目的确定与3D-CRT相比，调强放射治疗是否能改善口咽癌患者经皮内窥镜胃造口术(PEG)管和治疗相关毒性结果。2000年至2009年在南卡罗来纳医科大学霍林斯癌症中心门诊接受明确治疗的口咽鳞状细胞癌患者或接受头颈部放射治疗的患者。通过调强放疗或3D-CRT接受每日35次放射治疗的介入剂量为70Gy.主要结果和测量主要终点包括放疗开始一年后对聚乙二醇管的依赖，治疗过程中的体重减轻，以及东部合作肿瘤组表现状态的变化。结果与3D-CRT组(n=56)相比，在所有患者(P=.02)和T分期晚期患者(P=.01)中，IMRT组(n=103)在治疗开始后1年的聚乙二醇管依赖率显著低于3D-CRT组(P=.01)，且拔管时间较短(P<；.001)。调强放射治疗组皮肤和粘膜急性3级或更大毒性反应的发生率较低(分别为P=0.02和P<；.001)。两组在体重减轻、治疗失败(风险比，0.82[95%CI，0.47-1.41])、总存活率(P=.45)或无病存活率(P=.26)方面没有显著差异。结论与3D-CRT相比，在口咽原发癌的治疗中，使用调强适形放射治疗显著改善了聚乙二醇管和毒性相关的结果。鉴于粘膜毒性效应、对聚乙二醇管的依赖和吞咽困难之间的关联，这些发现可能是调强放射治疗改善吞咽结果的一个迹象。
IMPORTANCE Approximately 50% of head and neck cancer survivors experience dysphagia and related morbidity. Intensity-modulated radiation therapy (IMRT) is increasingly used to treat oropharyngeal cancers with excellent oncologic outcomes, but few studies have compared it with conventional 3-dimensional conformal radiation therapy (3D-CRT) to determine whether it can decrease treatment-related toxic and adverse effects.OBJECTIVE To determine whether IMRT improves percutaneous endoscopic gastrostomy (PEG) tube and treatment-related toxicity outcomes compared with 3D-CRT in patients with oropharyngeal squamous cell carcinoma.DESIGN, SETTING, AND PARTICIPANTS Retrospective review of 159 patients with oropharyngeal primary tumors with no history of chemotherapy, radiation therapy, or surgery of the head and neck who underwent definitive treatment with radiotherapy for oropharyngeal squamous cell carcinoma at the Hollings Cancer Center outpatient clinic, Medical University of South Carolina, from 2000 to 2009.INTERVENTION Doses of 70 Gy in 35 daily fractions of radiotherapy delivered via IMRT or 3D-CRT.MAIN OUTCOMES AND MEASURES Primary end points included PEG tube dependence 1 year after radiotherapy start, weight loss during treatment, and change in Eastern Cooperative Oncology Group performance status. Secondary end points included overall and disease-free survival, disease recurrence, and toxic effect profiles.RESULTS The IMRT group (n = 103) had a significantly lower rate of PEG tube dependence 1 year after treatment initiation than the 3D-CRT group (n = 56) for all patients (P = .02) and for those with advanced T stage (P = .01) and a shorter time to PEG tube removal (P < .001). Acute grade 3 or greater toxic effects to skin and mucous membranes occurred less frequently in the IMRT group (P = .02 and P < .001, respectively). The 2 groups did not differ significantly in weight loss, treatment failure (hazard ratio, 0.82 [95% CI, 0.47-1.41]), overall survival (P = .45), or disease-free survival (P = .26).CONCLUSIONS AND RELEVANCE The use of IMRT significantly improves PEG tube and toxicity-related outcomes compared with 3D-CRT in the treatment of oropharyngeal primary cancers. Given the association between mucosal toxic effects, PEG tube dependence, and dysphagia, these findings may be an indication of improved swallowing outcomes with IMRT.