复发或第二原发头颈癌剂量绘画再照射后的临床结果。

文献信息

中文摘要

目的： 复发或第二原发头颈癌（rsHNC）由于先前照射组织的耐受性有限，给放射治疗带来挑战。这些患者可能受益于剂量绘画（DP），该方法专注于将最大剂量递送到高肿瘤负荷区域，同时遵守危及器官的剂量约束。在本研究中，我们比较了一组接受标准再照射的患者与一组接受18F-氟脱氧葡萄糖（FDG）PET/CT引导DP的患者的临床结果。
方法： 我们的标准再照射方案是超分割放疗（RT）1.5 Gy x 40（总剂量60 Gy）。对于DP，我们定义了两个基于FDG的处方体积，分别接受至少65 Gy和70 Gy。比较了13名接受标准RT的患者与10名DP患者。毒性使用CTCAE v3.0评分。疾病相关终点包括局部区域控制（LRC）、无病生存期（DFS）和总生存期（OS）。
结果： 平均复合毒性评分在RT结束时最高，不同CTCAE项目的模式各异。除6个月时吞咽困难外，两组间未发现毒性显著差异，标准RT组评分更差（p=0.01）。LRC和DFS未发现差异。DP组两年OS为50%，标准组为15%（p=0.04），尽管这可能反映标准组更高的合并症。
结论： rsHNC的DP与标准再照射相比未增加毒性。未发现疾病控制改善的证据。然而，DP可能使选定患者受益，未来研究应侧重于识别这些候选者。
临床试验注册： https://clinicaltrials.gov，标识符NCT02921581。

英文摘要

PURPOSE: Recurrent or second primary head and neck cancer (rsHNC) presents a radiotherapeutic challenge due to limited tolerance of previously irradiated tissues. These patients could benefit from dose painting (DP), which focuses on delivering maximal dose to areas of high tumor burden while respecting dose constraints to organs at risk. In this study, we compare clinical outcomes in one group receiving standard reirradiation with a group receiving 18F-fluorodeoxyglucose (FDG) PET/CT-guided DP.
METHODS: Our standard reirradiation regimen is hyperfractionated radiotherapy (RT) of 1.5 Gy x 40 (60 Gy total dose). For DP, we defined two FDG-based prescription volumes receiving at least 65 Gy and 70 Gy. Thirteen patients receiving standard RT were compared with 10 DP patients. Toxicity was scored using CTCAE v3.0. Disease-related endpoints were locoregional control (LRC), disease-free survival (DFS) and overall survival (OS).
RESULTS: The mean composite toxicity score was maximal at the end of RT, with varying patterns across the CTCAE items. No significant difference in toxicity was found between the groups except for dysphagia at 6 months, where the standard RT group had worse scores (p=0.01). No differences were found in LRC and DFS. Two-year OS was 50% in the DP group versus 15% in the standard group (p=0.04), although this may reflect higher comorbidity in the standard group.
CONCLUSION: DP of rsHNC did not increase toxicity compared with standard reirradiation. No evidence of improved disease control was found. However, DP may benefit selected patients, and future studies should focus on identifying these candidates.
CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov, identifier NCT02921581.