局部晚期下咽癌调强放疗剂量分割模式改变对急性放疗反应的影响

摘要

Objective: To evaluate the feasibility of hypofractionated intensity-modulated radiation therapy (IMRT) combined with concurrent chemotherapy in patients with locally advanced squamous cell carcinoma of the hypopharynx. Methods:Patients with stageⅢ-ⅣA carcinoma of the hypopharynx were treated with IMRT and cisplatin-based concurrent chemotherapy. Two groups were di-vided according to the prescription dose to the primary gross tumor volume, as follows:Cohort-1 comprised patients who were recruit-ed before February 2013 (70 Gy/33 F and 2.12 Gy/F);and Cohort-2 comprised patients who were recruited since February 2013 (69 Gy/30 F and 2.30 Gy/F). Acute toxicities were evaluated. This study was registered with the number ChiCTR-ONRC-14004240. Results:Between August 2008 and December 2014, a total of 76 patients (35 in Cohort-1 and 41 in Cohort-2) were recruited. No xerostomia of grade 3 and higher was observed in all patients, who showed low incidences of grade 3 skin reaction, oral mucositis, and dysphagia. All patients did not show acute toxicities of higher than grade 4. No statistical differences in acute toxicities were observed between the two cohorts. No statistical difference was observed in acute toxicities between the IMRT techniques. Induction chemotherapy was the inde-pendent prognostic factor for grade 2 xerostomia (P=0.002). Conclusion:The 69 Gy/30 F hypofractionated IMRT was safe and effec-tive in the treatment of locally advanced squamous cell carcinoma of the hypopharynx. Late toxicities and long-term outcome need to be investigated further.%目的：评价改变剂量分割模式的调强放疗同步联合化疗治疗局部晚期下咽鳞癌的安全性。方法：对解放军总医院调强放疗（IMRT）联合含顺铂方案化疗的下咽鳞癌患者进行改变分割剂量的研究。以pGTV的处方剂量分为2组：常规剂量组（组1）自2008年8月至2013年2月，为回顾性分析，pGTV处方剂量70 Gy，2.12 Gy/f，共33次，5次/周；试验剂量组（组2）自2013年2月开始，为前瞻性分析，pGTV处方剂量69 Gy，2.30 Gy/f，共30次，5次/周。比较两种剂量分割模式对急性不良反应的影响。结果：自2008年8月1日至2014年12月1日共76例符合入组条件的患者完成放疗，其中组1含35例，组2含41例。全组患者无3级口干症，3级皮肤损伤、口腔黏膜炎及吞咽困难的发生率较低，无≥4级不良反应。两组的急性皮肤损伤、口干症、口腔黏膜炎、吞咽困难比较差异无统计学意义（P>0.05）。IMRT技术差异对急性不良反应无明显影响。诱导化疗（ICT）为急性口干症的独立性影响因子（P=0.002）。结论：初步结果显示，69 Gy/30 f剂量分割模式IMRT在下咽癌安全有效，远期不良反应及疗效仍需进一步观察。