Comparisons of the clinical outcomes of different postoperative radiation strategies for treatment of head and neck squamous cell carcinoma.
Comparisons of the clinical outcomes of different postoperative radiation strategies for treatment of head and neck squamous cell carcinoma.
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不同术后放射策略治疗头颈鳞状细胞癌的临床结果比较。
DOI：
10.1093/jjco/hyx137
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Hasegawa Y
中科院分区：
文献类型：
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作者：
Makita C;Kodaira T;Daimon T;Tachibana H;Tomita N;Koide Y;Koide Y;Fukuda Y;NishikawaD;Suzuki H;Hanai N;Hasegawa Y
目的我们以前报道过头颈部鳞状细胞癌患者术后有限野放射治疗的局部区域控制效果不佳，因此我们修改了策略以覆盖整个颈部。方法2010年以前，临床靶区覆盖瘤床和/或累及颈部。自2011年以来，计划进行全颈照射。进行单变量分析、多变量分析和倾向评分匹配。该研究纳入了275例患者：186例接受了有限野术后放疗，89例接受了全颈术后放疗。整个队列的中位随访时间为40.8 months.ResultsIn单变量分析，放射治疗策略对总生存期和无进展生存期没有显着影响。在多变量分析中，全颈术后放疗是总生存率、无进展生存率和局部控制的有利因素。倾向评分匹配导致一个队列，包括118名匹配良好的患者，平均分为有限野术后放疗组和全颈术后放疗组。全颈术后放疗组的2年总生存率（56.4% vs. 78.1%;P= 0.003）、2年无进展生存率（34.7% vs. 59.8%;P= 0.009）和2年局部区域控制率（54.4% vs. 83.2%;P< 0.001）明显更好。局限野术后放疗组的局部复发率明显高于局限野术后放疗组，（35.2% vs. 15.1%，P = 0.003）和场外结论全颈术后放疗比局限野术后放疗能更好地提高患者的生存率，无进展生存和局部控制。
PurposeWe previously reported unfavorable locoregional control with limited field postoperative radiotherapy for head and neck squamous cell carcinoma patients and thus revised the strategy to cover the whole neck. Head and neck squamous cell carcinoma Patients’ outcomes were retrospectively analyzed to compare the efficacy of two treatments.Material and methodsBefore 2010, the clinical target volume covered the tumor bed and/or involved the neck region. Since 2011, whole-neck irradiation was planned. Univariate analysis, multivariate analysis, and propensity score matching were performed. The study included 275 patients: 186 received limited field postoperative radiotherapy and 89 received whole-neck postoperative radiotherapy. The median follow-up time for the entire cohort was 40.8 months.ResultsIn univariate analysis, the radiation strategy had no significant effect on overall survival and progression-free survival. In multivariate analysis, whole-neck postoperative radiotherapy was a favorable factor for overall survival, progression-free survival, and locoregional control. Propensity score matching resulted in a cohort comprising 118 well-matched patients evenly divided between the limited field postoperative radiotherapy and whole-neck postoperative radiotherapy groups. Whole-neck postoperative radiotherapy group achieved a significantly better 2-year overall survival (56.4% vs. 78.1%;P= 0.003), 2-year progression-free survival (34.7% vs. 59.8%;P= 0.009), and 2-year locoregional control (54.4% vs. 83.2%;P< 0.001). The limited field postoperative radiotherapy group developed significantly more locoregional recurrences both in-field (35.2% vs. 15.1%,P= 0.003) and out-of-field (25.0% vs. 0%,P< 0.001) in the matched-pair cohort.ConclusionWhole-neck postoperative radiotherapy is a more appropriate choice than limited field postoperative radiotherapy to improve overall survival, progression-free survival and locoregional control.