Clinical Outcomes and Patterns of Disease Recurrence After Intensity Modulated Proton Therapy for Oropharyngeal Squamous Carcinoma.
Clinical Outcomes and Patterns of Disease Recurrence After Intensity Modulated Proton Therapy for Oropharyngeal Squamous Carcinoma.
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DOI：
10.1016/j.ijrobp.2016.02.021
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发表时间：
2016-05-01
期刊：
影响因子：
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通讯作者：
Frank SJ
中科院分区：
文献类型：
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作者：
Gunn GB;Blanchard P;Garden AS;Zhu XR;Fuller CD;Mohamed AS;Morrison WH;Phan J;Beadle BM;Skinner HD;Sturgis EM;Kies MS;Hutcheson KA;Rosenthal DI;Mohan R;Gillin MT;Frank SJ
我们进行了一项单机构前瞻性研究，以评估质子治疗头颈癌患者的疾病控制和毒性。采用强度调节质子治疗（IMPT）的口咽鳞状癌（OPC）患者初始队列的疾病控制、毒性、功能结局和失败模式被前瞻性地收集在同一机构的两项登记研究中。利用可变形图像配准方法分析局部区域故障。2011年3月至2014年7月接受治疗的50例OPC患者组成队列。84%为男性，50%从不吸烟，98%为p16+， 98%为III/IV期疾病，64%同时接受化疗，35%接受诱导化疗。45例肿瘤中有44例（98%）p16检测呈阳性。所有患者均接受IMPT治疗（多场优化n=46，单场优化n=4）。未见CTC-AE 4/5级毒性反应。最常见的3级急性和晚期毒性是急性粘膜炎和晚期吞咽困难，分别为58%和12%。11例患者在治疗期间进行了喂养胃造口术，但最后随访中没有人使用喂食管。中位随访29个月，5例患者出现疾病复发：1例局部复发，1例局部和局部复发，2例局部复发，1例远处复发。2年精算总生存率和无进展生存率分别为94.5%和88.6%。IMPT治疗OPC的肿瘤学、毒性和功能结果令人鼓舞，并为正在进行和未来的临床研究提供了基础。
A single institution prospective study was conducted to assess disease control and toxicity of proton therapy for patients with head and neck cancer. Disease control, toxicity, functional outcomes and patterns of failure for the initial cohort of patients with oropharyngeal squamous carcinoma (OPC) treated with intensity modulated proton therapy (IMPT) were prospectively collected in two registry studies at a single institution. Locoregional failures were analyzed utilizing deformable image registration methodology. Fifty patients with OPC treated from 03/2011 to 07/2014 formed the cohort. Eight-four percent were male, 50% were never smokers, 98% were p16+, 98% had stage III/IV disease, 64% received concurrent and 35% received induction chemotherapy. Forty-four of 45 (98%) tumors tested for p16 were positive. All patients were treated with IMPT (multi-field optimization n=46; single-field optimization n=4). No CTC-AE grade 4/5 toxicities were observed. The most common grade 3 acute and late toxicities observed were acute mucositis and late dysphagia, in 58% and 12%, respectively. Eleven patients had a feeding gastrostomy placed during therapy, but none had a feeding tube at last follow up. With a median follow up of 29 months, 5 patients had disease recurrence: local in 1, local and regional in 1, regional in 2, and distant in 1. The 2-year actuarial overall and progression free survival were 94.5% and 88.6%, respectively. The oncologic, toxicity and functional outcomes following IMPT for OPC are encouraging and provide the basis for ongoing and future clinical studies.