口咽癌保留对侧下颈部选择性放疗后的客观吞咽结局：单机构临床经验
Objective Swallowing Outcomes After Sparing Contralateral Low-Neck Elective Radiotherapy in Oropharyngeal Carcinoma: Single-Institution Clinical Experience.
文献信息
| PMID | 42726920 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Rex H Lee |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA. |
| 期刊 | Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 吞咽困难是口咽鳞状细胞癌（OPSCC）放化疗（CRT）的主要毒性反应。选择性上颈部照射（UNI），即省略下颈部，可能降低食管入口肌（EIM）剂量，并较选择性全颈部照射（WNI）改善吞咽结局。我们比较了UNI与WNI后的吞咽结局。
研究设计： 2015年至2023年的回顾性综述。
地点： 三级学术中心。
方法： 我们回顾性审查了接受根治性CRT的OPSCC患者，这些患者接受了基线和治疗后的视频荧光吞咽研究（VFSS）。结局包括吞咽运动学、VFSS功能性指标、喂养管置入和复发。
结果： 共纳入52例p16阳性OPSCC患者：28例（54%）接受UNI，24例（46%）接受WNI。治疗组之间的T和N分期均衡。UNI和WNI之间的声门上、声门和咽缩肌剂量相似。UNI的EIM剂量低于WNI（29.8 vs 36.1 Gy，P = .011）。与WNI相比，UNI与CRT期间/之后喂养管置入发生率较低相关（22% vs 57%，P = .00643），并且在调整T/N分期和EIM剂量后，UNI与CRT后1年喂养管置入风险降低相关（风险比[HR] 0.25，P = .006）。在食管扩张、肺炎或复发发生率方面未见差异。在省略的对侧下颈部未观察到疾病复发。
结论： 与WNI相比，UNI与EIM剂量降低和喂养管置入率降低相关，且未损害疾病控制。在需要选择性对侧颈部照射的OPSCC患者中，省略对侧下颈部是一种有前景的降阶梯策略。
英文摘要
OBJECTIVE: Dysphagia is a major toxicity of chemoradiation (CRT) for oropharyngeal squamous cell carcinoma (OPSCC). Elective upper-neck irradiation (UNI), omitting the low neck, may reduce esophageal inlet muscle (EIM) dose and improve swallowing outcomes compared to elective whole-neck irradiation (WNI). We compared swallowing outcomes after UNI versus WNI.
STUDY DESIGN: Retrospective review from 2015 to 2023.
SETTING: Tertiary academic center.
METHODS: We retrospectively reviewed OPSCC patients treated with definitive CRT who underwent baseline and post-treatment videofluoroscopic swallow studies (VFSSs). Outcomes included swallowing kinematics, functional VFSS measures, feeding tube placement, and recurrence.
RESULTS: Fifty-two patients with p16-positive OPSCC were included: 28 (54%) UNI and 24 (46%) WNI. T and N stages were balanced between treatment groups. Supraglottic, glottic, and constrictor doses were similar between UNI and WNI. EIM dose was lower in UNI than WNI (29.8 vs 36.1 Gy, P = .011). UNI was associated with a lower incidence of feeding tube placement during/after CRT than WNI (22% vs 57%, P = .00643) and reduced hazards of feeding tube placement at 1 year post-CRT when adjusted for T/N stage and EIM dose (hazard ratio [HR] 0.25, P = .006). No differences were seen in the incidence of esophageal dilation, pneumonia, or recurrence. No disease relapse was observed in the omitted contralateral low neck.
CONCLUSION: UNI was associated with reduced EIM dose and lower rates of feeding tube placement compared to WNI, without compromising disease control. In OPSCC patients requiring elective contralateral neck irradiation, omitting the contralateral low neck is a promising de-escalation strategy.