The role of radiotherapy in the treatment of malignant salivary gland tumors
The role of radiotherapy in the treatment of malignant salivary gland tumors
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DOI：
10.1016/j.ijrobp.2004.03.018
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发表时间：
2005-01-01
影响因子：
7
通讯作者：
Burlage, F
中科院分区：
文献类型：
--
作者：
Terhaard, CHJ;Lubsen, H;Burlage, F
目的：我们分析了538例患者治疗涎腺癌的荷兰头颈部肿瘤合作组的中心，在寻找预后因素和剂量responsibility.Methods和材料的作用，原发性和术后低线性能量转移放射治疗：肿瘤位于腮腺中的59%，下颌下腺中的14%，口腔中的23%，和其他地方的5%。498名患者中，有386名患者接受了手术与放疗相结合的治疗，中位剂量为62戈伊。手术和放疗之间的中位延迟时间为6周。在术后放疗组中，不良预后因素占主导地位。40%的患者接受了选择性颈部放疗，中位剂量为50戈伊。对于不可切除的疾病或M-1给予初次放疗（n = 40），剂量范围为28-74戈伊。与单纯手术相比，术后放疗显著改善了T3-4肿瘤的10年局部控制（84% vs. 18%）、闭合（95% vs. 55%）和不完全切除（82% vs. 44%）、骨浸润（86% vs. 54%）和神经周围浸润（88% vs. 60%）。局部控制与手术和放疗之间的间隔时间无关。未显示剂量-反应关系。术后放疗显著改善了pN（+）颈部的区域控制（86% vs. 62%，单纯手术）。不同部位、T分期和组织学类型的分级量表可用于计算就诊时颈部疾病的风险，从而表明是否需要选择性颈部治疗。观察到边际剂量反应，剂量大于或等于46戈伊更有利。一个明确的剂量-反应关系，显示了与原发性放射治疗的患者。5年局部控制率为50%，剂量为66-70戈伊。结论：术后放疗剂量至少为60戈伊适用于T3-4肿瘤、不完全或闭合切除、骨侵犯、神经周围侵犯和pN（+）的患者。对于不可切除的肿瘤，建议剂量至少为66戈伊。(C)2005年爱思唯尔公司
Purpose: We analyzed the role of primary and postoperative low linear energy transfer radiotherapy in 538 patients treated for salivary gland cancer in centers of the Dutch Head and Neck Oncology Cooperative Group, in search for prognostic factors and dose response.Methods and Materials: The tumor was located in the parotid gland in 59%, submandibular gland in 14%, oral cavity in 23%, and elsewhere in 5%. In 386 of 498 patients surgery was combined with radiotherapy, with a median dose of 62 Gy. Median delay between surgery and radiotherapy was 6 weeks. In the postoperative radiotherapy group, adverse prognostic factors prevailed. Elective radiotherapy to the neck was given in 40%, with a median dose of 50 Gy. Primary radiotherapy (n = 40) was given for unresectable disease or M-1, with a dose range of 28-74 Gy.Results: Postoperative radiotherapy improved 10-year local control significantly compared with surgery alone in T3-4 tumors (84% vs. 18%), in patients with close (95% vs. 55%) and incomplete resection (82% vs. 44%), in bone invasion (86% vs. 54%), and perineural invasion (88% vs. 60%). Local control was not correlated with interval between surgery and radiotherapy. No dose-response relationship was shown. Postoperative radiotherapy significantly improved regional control in the pN(+) neck (86% vs. 62% for surgery alone). A rating scale for different sites, T stage, and histologic type may be applied to calculate the risk of disease in the neck at presentation, and so indicate the need for elective neck treatment. A marginal dose-response was seen, in favor of a dose greater than or equal to46 Gy. A clear dose-response relationship was shown for patients treated with primary radiotherapy. Five-year local control was 50% with a dose of 66-70 Gy.Conclusions: Postoperative radiotherapy with a dose of at least 60 Gy is indicated for patients with T3-4 tumors, incomplete or close resection, bone invasion, perineural invasion, and pN(+). In unresectable tumors, a dose of at least 66 Gy is advisable. (C) 2005 Elsevier Inc.