CLINICAL IMPLICATIONS OF THE TUMOR VOLUME REDUCTION RATE IN HEAD-AND-NECK CANCER DURING DEFINITIVE INTENSITY-MODULATED RADIOTHERAPY FOR ORGAN PRESERVATION
CLINICAL IMPLICATIONS OF THE TUMOR VOLUME REDUCTION RATE IN HEAD-AND-NECK CANCER DURING DEFINITIVE INTENSITY-MODULATED RADIOTHERAPY FOR ORGAN PRESERVATION
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DOI：
10.1016/j.ijrobp.2009.12.055
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发表时间：
2011-03-15
影响因子：
7
通讯作者：
Lin, Fang-Jen
中科院分区：
文献类型：
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作者：
Yang, Shih-Neng;Liao, Chih-Ying;Lin, Fang-Jen
目的：为探讨调强放疗（intensity modulated radiotherapy，IMRT）后肿瘤体积缩小率（volume reduction rate，VRR）对头颈部恶性肿瘤预后的预测价值，对76例口咽癌（oropharyngeal cancer，OPC）和76例下咽癌（hypopharyngeal cancer，HPC）患者进行了容积分析。所有患者均接受分配的放疗疗程。调强放疗开始后4 ~ 5周进行自适应计算机断层扫描。原发性肿瘤体积测量使用单独的图像为治疗前总肿瘤体积（pGTV）和间隔总肿瘤volume.Results：在OPC组，pGTV范围为6.6至242.6 mL（平均值，49.9 mL），而VRR值范围为0.014至0.74（平均值，0.43）。在HPC患者中，pGTV范围为4.1至152.4 mL（平均值为35.6 mL），而VRR范围为-1.15至0.79（平均值为0.33）。OPC的原发肿瘤无复发生存率的多变量分析揭示了三个预后因素：T4肿瘤（p = 0.0001，风险比7.38），pGTV >= 20 mL（p = 0.01，风险比10.61）和VRR < 0.5（p = 0.001，风险比6.49）。多因素分析显示，影响HPC原发肿瘤无复发生存率的两个预后因素为pGTV >= 30 mL（p = 0.001，hazardratio 2.87）和VRR < 0.5（p = 0.03，hazardratio 2.25）。对于肿瘤体积较大或VRR < 0.5的患者，应考虑进行挽救手术或剂量递增方案。(C)2011 Elsevier Inc.
Purpose: To investigate the prognostic value of the volume reduction rate (VRR) in patients with head-and-neck cancer treated with intensity-modulated radiotherapy (IMRT).Methods and Materials: Seventy-six patients with oropharyngeal cancer (OPC) and another 76 with hypopharyngeal cancer (HPC) were enrolled in volumetric analysis. All patients received allocated radiotherapy courses. Adaptive computed tomography was done 4 to 5 weeks after the start of IMRT. Primary tumor volume measurement was derived using separate images for the pretreatment gross tumor volume (pGTV) and the interval gross tumor volume.Results: In the OPC group, the pGTV ranged from 6.6 to 242.6 mL (mean, 49.9 mL), whereas the value of the VRR ranged from 0.014 to 0.74 (mean, 0.43). In HPC patients, the pGTV ranged from 4.1 to 152.4 mL (mean, 35.6 mL), whereas the VRR ranged from -1.15 to 0.79 (mean, 0.33). Multivariate analysis of the primary tumor relapse-free survival for OPC revealed three prognostic factors: T4 tumor (p = 0.0001, hazard ratio 7.38), pGTV >= 20 mL (p = 0.01, hazard ratio 10.61), and VRR < 0.5 (p = 0.001, hazard ratio 6.49). Multivariate analysis of the primary tumor relapse-free survival for HPC showed two prognostic factors: pGTV >= 30 mL (p = 0.001, hazard ratio 2.87) and VRR < 0.5 (p = 0.03, hazard ratio 2.25).Conclusion: The VRR is an outcome predictor for local control in OPC and HPC patients treated with IMRT. Those with large tumor volumes or a VRR < 0.5 should be considered for a salvage operation or a dose-escalation scheme. (C) 2011 Elsevier Inc.