Patterns of Failure after Intensity-modulated Radiotherapy in Head and Neck Squamous Cell Carcinoma using Compartmental Clinical Target Volume Delineation
Patterns of Failure after Intensity-modulated Radiotherapy in Head and Neck Squamous Cell Carcinoma using Compartmental Clinical Target Volume Delineation
复制标题
DOI：
10.1016/j.clon.2014.05.001
复制
发表时间：
2014-10-01
影响因子：
3.4
通讯作者：
Sen, M.
中科院分区：
文献类型：
--
作者：
Bayman, E.;Prestwich, R. J. D.;Sen, M.
目的：探讨非鼻咽头颈部鳞状细胞癌根治性调强放疗加化疗或不加化疗患者的复发方式，以及局部复发部位与放疗靶区体积的关系。材料和方法：回顾分析2008~2011年间136例非鼻咽头颈部鳞状细胞癌根治性调强放疗加化疗或不加化疗患者的复发情况。在此期间，临床靶区(CTV)的划分方法被常规使用，调强放射治疗采用5-7角阶梯和射门技术。结果：中位随访期31(3~53)个月，局部复发通过可变形图像联合配准和目测重建，并与靶区体积和剂量进行相关性分析。2年局控率为86%，区域控制率为93%，无瘤生存率为78%，无远处转移生存率为89%，总生存率为79%。120例(88%)患者对治疗完全有效，7例(6%)随后局部复发。对这些复发的分析显示，5例位于内野；1例位于大剂量CTV的边缘；1例位于外野。总体而言，边缘/视野外的复发率为2/136(1.5%)。结论：采用分区方法进行CTV勾画的调强放疗与边缘/视野外的低复发率有关。(C)2014年皇家放射科医生学会。爱思唯尔有限公司出版。保留所有权利。
Aims: To determine the pattern of disease recurrence in non-nasopharyngeal head and neck squamous cell carcinoma (HNSCC) patients treated with radical intensity-modulated radiotherapy (IMRT) with or without chemotherapy, and to correlate the sites of locoregional recurrence with radiotherapy target volumes.Materials and methods: In total, 136 patients treated with radical IMRT with or without chemotherapy between 2008 and 2011 for non-nasopharyngeal HNSCC were retrospectively identified. A compartmental approach to clinical target volume (CTV) delineation was routinely utilised during this period and IMRT was delivered using a 5-7 angle step and shoot technique. Locoregional recurrences were reconstructed on the planning computed tomography scan by both deformable image coregistration and by visual assessment, and were analysed in relation to target volumes and dosimetry.Results: The median follow-up was 31 (range 3-53) months. Two year local control, regional control, disease-free survival, distant metastasis-free survival and overall survival were 86, 93, 78, 89 and 79%, respectively. One hundred and twenty of 136 (88%) patients achieved a complete response to treatment and 7/120 (6%) have subsequently had a locoregional recurrence. Analysis of these recurrences revealed five to be infield; one to be marginal to the high-dose CTV; one to be out-of-field. Overall the marginal/out-of-field recurrence rate was 2/136 (1.5%).Conclusions: IMRT utilising a compartmental approach to CTV delineation was associated with a low rate of marginal/out-of-field recurrence. (C) 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.