POSTOPERATIVE EXTERNAL BEAM RADIOTHERAPY FOR DIFFERENTIATED THYROID CANCER: OUTCOMES AND MORBIDITY WITH CONFORMAL TREATMENT
POSTOPERATIVE EXTERNAL BEAM RADIOTHERAPY FOR DIFFERENTIATED THYROID CANCER: OUTCOMES AND MORBIDITY WITH CONFORMAL TREATMENT
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DOI：
10.1016/j.ijrobp.2008.09.023
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发表时间：
2009-07-15
影响因子：
7
通讯作者：
Garden, Adam S.
中科院分区：
文献类型：
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作者：
Schwartz, David L.;Lobo, Mark J.;Garden, Adam S.
目的：回顾分化型甲状腺癌术后适形外照射(EBRT)患者的预后。方法与材料：对1996年1月至2005年12月连续接受EBRT治疗的131例分化型甲状腺癌患者进行单机构回顾性分析。组织学诊断为乳头状型104例，滤泡型21例，乳头-滤泡型混合型6例。美国癌症联合委员会分期分布为III期2例，Iva-IVC期128例，1例不可评估。34例(26%)患者有高危组织学类型，76例(58%)有复发疾病。腺外扩散126例(96%)，手术切缘镜检阳性62例(47%)，大体残留病变15例(11%)。EBRT中位剂量为60Gy38~72Gy.57例患者(44%)接受调强放疗，中位剂量为60Gy56~66Gy.中位随访期38个月(范围0-134个月)。结果：Kaplan-Meier估计的局部区域无复发生存率、疾病特异性生存率和4年总生存率分别为79%、76%和73%。在多变量分析中，高危组织学特征和大体残留病变预测下局部无复发生存率，而高危组织学特征、M1病和大体残留病变预测下区域无复发生存率。调强放疗不影响生存结果，但与较少的严重晚期发病率(12%比2%)有关。结论：如果疾病减少到微观负担，适形EBRT为高危分化型甲状腺癌患者提供了持久的局部区域疾病控制。患有严重疾病的患者面临明显更糟糕的结果。调强放射治疗可显著降低慢性放射发病率，但需要进一步研究。(C)2009年爱思唯尔公司。
Purpose: To review institutional outcomes for patients treated for differentiated thyroid cancer with postoperative conformal external beam radiotherapy (EBRT).Methods and Materials: This is a single-institution retrospective review of 131 consecutive patients with differentiated thyroid cancer who underwent EBRT between January 1996 and December 2005. Histologic diagnoses included 104 papillary, 21 follicular, and six mixed papillary-follicular types. American Joint Committee on Cancer stage distribution was Stage III in 2 patients, Stage IVa-IVc in 128, and not assessable in 1. Thirty-four patients (26%) had high-risk histologic types and 76 (58%) had recurrent disease. Extraglandular disease spread was seen in 126 patients (96%), microscopically positive surgical margins were seen in 62 patients (47%), and gross residual disease was seen in 15 patients (11%). Median EBRT dose was 60 Gy (range, 38-72 Gy). Fifty-seven patients (44%) were treated with intensity-modulated radiotherapy (IMRT) to a median dose of 60 Gy (range, 56-66 Gy). Median follow-up was 38 months (range, 0-134 months).Results: Kaplan-Meier estimates of locoregional relapse-free survival, disease-specific survival, and overall survival 4 years were 79%, 76%, and 73%, respectively. On multivariate analysis, high-risk histologic features and gross residual disease predicted for inferior locoregional relapse-free survival, whereas high-risk histologic features, M1 disease, and gross residual disease predicted for inferior disease-specific and overall survival. The IMRT did not impact on survival outcomes, but was associated with less frequent severe late morbidity (12% vs. 2%).Conclusions: Postoperative conformal EBRT provides durable locoregional disease control for patients with high-risk differentiated thyroid cancer if disease is reduced to microscopic burden. Patients with gross disease face significantly worse outcomes. The IMRT may significantly reduce chronic radiation morbidity, but requires additional study. (C) 2009 Elsevier Inc.