Carotid blowout syndrome in pharyngeal cancer patients treated by hypofractionated stereotactic re-irradiation using CyberKnife: A multi-institutional matched-cohort analysis
Carotid blowout syndrome in pharyngeal cancer patients treated by hypofractionated stereotactic re-irradiation using CyberKnife: A multi-institutional matched-cohort analysis
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DOI：
10.1016/j.radonc.2015.02.021
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发表时间：
2015-04-01
影响因子：
5.7
通讯作者：
Yoshioka, Yasuo
中科院分区：
文献类型：
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作者：
Yamazaki, Hideya;Ogita, Mikio;Yoshioka, Yasuo
背景与目的：随着现代放射疗法的出现，再照射作为治疗复发性头颈部肿瘤的一种潜在疗法受到了人们的关注，但颈动脉爆裂综合征（CBOS）等严重的毒副作用限制了再照射的潜力。本研究的目的是确定低分割立体定向放疗（SBRT）后CBOS的危险因素。方法与患者：我们对四所医院接受射波刀再照射治疗的咽癌患者进行配对设计检查。60例无CBOS患者中有12例有CBOS。分析影响CBOS预后的因素，并建立风险分类模型。结果：在既往放疗60 Gy/30次后，射波刀SBRT的中位处方放射剂量为30 Gy/ 5次。从再照射到CBOS发病的中位持续时间为5个月（范围0-69个月）。CBOS病例的中位生存时间为5.5个月，而非CBOS病例的中位生存时间为22.8个月（1年生存率，36% vs. 72%; p = 0.003）。单因素分析发现颈动脉侵犯角度为>180度、溃疡的存在、计划治疗量和对淋巴结区域的照射是CBOS的统计学显著易感因素。只有颈动脉浸润180度的患者发生CBOS(12/ 50,24%)，而肿瘤浸润小于颈动脉半半圆的患者没有发生CBOS （0/ 22,0%, p = 0.03）。多因素Cox风险模型分析显示，溃疡的存在和淋巴结的照射是有统计学意义的易感因素。因此，我们构建了CBOS风险分级体系：CBOS指数=（危险因素总和；颈动脉侵犯>180度，有无溃疡，淋巴结区辐照）。这个系统充分区分了风险群体。结论：溃疡和淋巴结照射是CBOS发生的危险因素。CBOS指数，包括颈动脉侵犯bbb180度，在分类危险因素和确定再照射指征方面是有用的。(C) 2015年由爱思唯尔爱尔兰有限公司出版。
Background and purpose: Although reirradiation has attracted attention as a potential therapy for recurrent head and neck tumors with the advent of modern radiotherapy, severe rate toxicity such as carotid blowout syndrome (CBOS) limits its potential. The aim of this study was to identify the risk factors of CBOS after hypofractionated stereotactic radiotherapy (SBRT).Methods and patients: We conducted a matched-pair design examination of pharyngeal cancer patients treated by CyberKnife reirradiation in four institutes. Twelve cases with CBOS were observed per 60 cases without CBOS cases. Prognostic factors for CBOS were analyzed and a risk classification model was constructed.Results: The median prescribed radiation dose was 30 Gy in 5 fractions with CyberKnife SBRT after 60 Gy/30 fractions of previous radiotherapy. The median duration between reirradiation and CBOS onset was 5 months (range, 0-69 months). CBOS cases showed a median survival time of 5.5 months compared to 22.8 months for non-CBOS cases (1-year survival rate, 36% vs. 72%; p = 0.003). Univariate analysis identified an angle of carotid invasion of >180 degrees, the presence of ulceration, planning treatment volume, and irradiation to lymph node areas as statistically significant predisposing factors for CBOS. Only patients with carotid invasion of >180 degrees developed CBOS (12/50, 24%), whereas no patient with tumor involvement less than a half semicircle around the carotid artery developed CBOS (0/22, 0%, p = 0.03). Multivariate Cox hazard model analysis revealed that the presence of ulceration and irradiation to lymph nodes were statistically significant predisposing factors. Thus, we constructed a CBOS risk classification system: CBOS index = (summation of risk factors; carotid invasion >180 degrees, presence of ulceration, lymph node area irradiation). This system sufficiently separated the risk groups.Conclusion: The presence of ulceration and lymph node irradiation are risk factors of CBOS. The CBOS index, including carotid invasion of >180 degrees, is useful in classifying the risk factors and determining the indications for reirradiation. (C) 2015 Published by Elsevier Ireland Ltd.