头颈部癌症大分割放疗的多中心回顾性队列研究。
A Multicentre Retrospective Cohort Study of Hypofractionated Radiotherapy in Head and Neck Cancer.
文献信息
| PMID | 42759386 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | D Miller |
| 作者单位 | Radiotherapy Department, Maidstone and Tunbridge Wells NHS Trust, Hermitage Ln, Maidstone, ME16 9QQ, UK. |
| 期刊 | Clinical oncology (Royal College of Radiologists (Great Britain)) |
| SCI 分区 | Q3 |
| IF | 3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 许多头颈部鳞状细胞癌（HNSCC）可通过根治性放疗治愈，但超过6-7周的传统分割方案可能难以耐受。自COVID-19大流行以来，以及近期HYPNO试验结果，对大分割（55 Gy分20次）的兴趣增加，但真实世界的疗效和毒性数据有限。我们评估了自采用容积调强弧形治疗（VMAT）以来在两个英国中心使用大分割的情况。
材料和方法： 通过电子医疗记录搜索，确定了转诊接受55 Gy分20次作为首次根治性治疗的HNSCC患者，排除早期声门癌。使用放射治疗肿瘤学组（RTOG）标准在治疗结束时和治疗后4周收集毒性数据。计算了胃造瘘管移除时间、完全缓解率、总生存期和无复发生存期。
结果： 2018年1月至2025年8月期间转诊了119名患者，其中113名（95%）完成了治疗。67名（57%）的ACE评分≥2，43名（37%）的体能状态≥2。大多数患者（76%）接受了原发灶和双侧颈部的治疗。治疗结束时，72名（64%）患有G3黏膜炎，51名（45%）患有G2吞咽困难，43名（38%）患有G2皮肤毒性，70名（62%）患有G2唾液腺毒性。54名（45%）有胃造瘘管，其中19个（35%）在完成治疗后三个月内移除。对于早期p16+口咽癌，完全缓解率为90%，3年总生存（OS）率为85%。
结论： 大分割可以安全地给予，其毒性与常规分割相当，但早期声门癌除外。
英文摘要
AIMS: Many squamous cell carcinomas of the head and neck (HNSCC) can be cured with radical radiotherapy, but conventional fractionation schedules over 6-7 weeks can be difficult to tolerate. Since the COVID-19 pandemic, and recent HYPNO trial results, interest in hypofractionation (55 Gy in 20#s) has increased, but real-world efficacy and toxicity data are limited. We evaluated the use of hypofractionation across two U.K. centres since adoption of volumetric-modulated arc therapy (VMAT).
MATERIALS AND METHODS: Electronic healthcare record searches identified patients with HNSCC referred for 55 Gy in 20#s as the first definitive treatment, excluding early glottic cancers. Toxicity data were captured using the Radiation Therapy Oncology Group (RTOG) criteria at end of treatment and 4 weeks post-treatment. Time to gastrostomy removal, complete response rates, overall and recurrence-free survival were calculated.
RESULTS: 119 patients were referred between January 2018 and August 2025, of whom 113 (95%) completed treatment. Sixty-seven (57%) had an ACE score of ≥2, and 43 (37%) had a performance status of ≥2. Most patients (76%) received treatment to the primary and bilateral neck. At end of treatment, 72 (64%) had G3 mucositis, 51 (45%) had G2 dysphagia, 43 (38%) had G2 skin toxicity, and 70 (62%) had G2 salivary toxicity. Fifty-four (45%) had gastrostomy tubes, 19 of which (35%) were removed within three months of completion. For early p16+ve oropharyngeal cancers, complete response rates were 90%, with 3-year overall survival (OS) rates of 85%.
CONCLUSION: Hypofractionation can be given safely with comparable toxicity to normofractionation outside of early glottic cancers.