口腔癌保留皮瓣术后放疗后的复发模式

文献信息

中文摘要

背景： 本研究评估接受保留皮瓣放疗（RT）的口腔癌（OCC）患者的复发模式和治疗结局。
方法： 回顾性分析2018年至2024年间因OCC接受手术及即刻游离皮瓣重建后行RT的患者。在靶区勾画中，高危临床靶区（CTV）为原生组织-皮瓣交界处，并额外外扩10 mm各向同性边界。我们估计了局部失败的累积发生率和几何模式。
结果： 34例患者符合纳入标准。中位随访时间为44个月。3例患者出现局部复发。2例复发发生在原生组织-皮瓣交界处，未见皮瓣内失败。观察到3例3级急性口腔黏膜炎、2例晚期3级吞咽困难和2例颌骨放射性骨坏死。未报告具有临床意义的皮瓣相关并发症。
结论： 保留皮瓣RT后未观察到皮瓣内局部复发。无需在CTV中刻意覆盖整个皮瓣。仍需进一步研究重建皮瓣的规划优化。

英文摘要

BACKGROUND: This study evaluates relapse patterns and treatment outcomes in oral cavity carcinoma (OCC) patients treated with flap-sparing radiotherapy (RT).
METHODS: Patients treated with surgery and immediate free-flap reconstruction followed by RT due to OCC between 2018 and 2024 were analyzed retrospectively. During target volume delineation, the high-risk clinical target volume (CTV) was the native tissue-flap interface with an additional isotropic margin of 10 mm. We estimated the cumulative incidence and geometric patterns of local failures.
RESULTS: Thirty-four patients matched the inclusion criteria. Median follow-up was 44 months. Three patients experienced local recurrences. Two relapses occurred at the native tissue-flap junction, with no intraflap failure. Three cases of Grade 3 acute oral mucositis, two cases of late Grade 3 dysphagia, and two cases of osteoradionecrosis of the jaw were observed. Clinically significant flap-related complication was not reported.
CONCLUSION: No intra-flap local recurrence was observed after flap-sparing RT. The entire flap does not need to be intentionally covered in the CTV. Further investigation of planning optimization for the reconstructed flap is needed.