Final results of local-regional control and late toxicity of RTOG 9003: a randomized trial of altered fractionation radiation for locally advanced head and neck cancer.
Final results of local-regional control and late toxicity of RTOG 9003: a randomized trial of altered fractionation radiation for locally advanced head and neck cancer.
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DOI：
10.1016/j.ijrobp.2013.12.027
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发表时间：
2014-05-01
期刊：
影响因子：
--
通讯作者：
Ang KK
中科院分区：
文献类型：
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作者：
Beitler JJ;Zhang Q;Fu KK;Trotti A;Spencer SA;Jones CU;Garden AS;Shenouda G;Harris J;Ang KK
检测与70戈伊的标准分割（SFX）相比，改变的放射分割方案是否改善了头颈部鳞状细胞癌（SCC）患者的局部区域控制（LRC）率。将III期或IV期（或II期舌根）SCC患者随机分为4个治疗组：（1）SFX-70戈伊/35次每日fxns/7周;（2）HFX-81.6戈伊/68 BID fxns/7周;（3）AFX-S 67.2戈伊/42 fxns/6周，38.4戈伊后休息2周;和（4）AFX-C 72戈伊/42 fxns/6周。n= 1 076。将3个实验组与SFX进行比较。在5年时对LRC进行删失的患者中，只有HFX与SFX的比较存在显着差异（HFX：风险比-0.79（0.62-1.00），p=0.05; AFX-C 0.82（0.65-1.05），p=0.11）。在5年时删失，HFX改善了总生存期（OS）（风险比0.81，p=0.05）。当实验组与SFX相比时，5年时任何3级、4级或5级毒性的患病率，180天后任何饲管使用或1年时饲管使用的患病率没有显著差异。当将7周治疗与6周治疗进行比较时，加速分割似乎增加了5年时的3级、4级或5级毒性（p=0.06）。按治疗查看每例患者的最严重毒性，当比较0-2级与3-5级毒性时，仅AFX-C组似乎倾向于比SFX组更差（p=0.09）。5年时，只有HFX改善了局部晚期SCC患者的LRC和OS，而不增加晚期毒性。
To test whether altered radiation fractionation schemes improved local-regional control (LRC) rates for patients with squamous cell cancers (SCC) of the head and neck when compared to standard fractionation (SFX) of 70 Gy. Patients with stage III or IV (or stage II base of tongue) SCC were randomized to 4 treatment arms: (1) SFX-70 Gy/35 daily fxns/7 week; (2) HFX-81.6 Gy/68 BID fxns/7 weeks; (3) AFX-S 67.2 Gy/42 fxns/6 weeks with a 2 week rest after 38.4 Gy; and (4) AFX-C 72 Gy/42 fxns/6 weeks. n=1,076. The 3 experimental arms were to be compared to SFX. With patients censored for LRC at 5 years, only the comparison of HFX with SFX was significantly different (HFX: Hazard Ratio-0.79(0.62–1.00), p=0.05; AFX-C 0.82 (0.65–1.05), p=0.11). Censored at 5 years, HFX improved Overall Survival (OS) (Hazard Ratio 0.81, p=0.05). Prevalence of any Grade 3, 4, or 5 toxicity at 5 years, any feeding tube use after 180 days, or feeding tube use at 1 year did not differ significantly when the experimental arms were compared to SFX. When 7 week treatments were compared to 6 week treatments, accelerated fractionation appeared to increase Grade 3, 4 or 5 toxicity at 5 years (p=0.06). Looking at the worst toxicity per patient by treatment only the AFX-C arm seemed to trend worse than the SFX arm when comparing Grade 0–2 vs. 3–5 toxicity(p=0.09). At 5 years, only HFX improved LRC & OS for patients with locally advanced SCC without increasing late toxicity.