PDF(Pubmed)
Abstract：
Unresectable, isolated lymph node recurrence after radiotherapy is rare but a candidate for re-irradiation. However, severe toxicity is anticipated. Therefore, this study aimed to explore the efficacy and toxicity of re-irradiation in isolated lymph node recurrence of head and neck lesions. We analyzed 46 patients who received re-irradiation for lymph node recurrence without local progression. The primary tumor sites included the oral cavity in 17 patients, the hypopharynx in 12, the oropharynx in seven, the larynx in three, the nasopharynx in two, and other sites. During a median follow-up time of 10 months, the median survival time was 10.6 months, and the 1-year overall survival rate was 45.5%. The 1-year local control and progression-free survival rates were 49.8% and 39.3%, respectively. According to univariate analysis, age (≥ 65 years), the interval between treatment (≥ 12 months), rN category (rN1), and gross tumor volume (GTV < 25 cm3) were predisposing factors for better survival. In the multivariate analysis, the rN category and interval were identified as statistically significant predictors. Late toxicity grade ≥ 3 occurred in four patients (8.6%). These were all Grade 5 carotid blowout syndrome, which associated with tumor invasion of the carotid artery and/ or high doses administration for the carotid artery. Small-volume rN1 tumor that recur after a longer interval is a feasible candidate for re-irradiation. However, strict patient selection and meticulous care for the carotid are required.
摘要：
不可切除,放疗后孤立的淋巴结复发很少见，但可再次放疗。然而,预计会有严重的毒性。因此,本研究旨在探讨头颈部病变孤立性淋巴结复发再次照射的疗效和毒性。我们分析了46例接受再次照射的淋巴结复发而没有局部进展的患者。原发肿瘤部位包括17例患者的口腔，12岁的下咽，7岁的口咽，三分钟的喉部，鼻咽一分为二,和其他网站。在10个月的中位随访时间内，中位生存时间为10.6个月,1年总生存率为45.5%。1年局部控制率和无进展生存率分别为49.8%和39.3%,分别。根据单变量分析，年龄（≥65岁），治疗间隔（≥12个月），rN类(rN1),和总肿瘤体积（GTV<25cm3）是更好的生存率的诱发因素。在多变量分析中，rN类别和间期被确定为有统计学意义的预测因子.4例患者（8.6%）发生晚期毒性≥3级。这些都是5级颈动脉爆裂综合征,这与颈动脉的肿瘤侵袭和/或颈动脉的高剂量给药有关。在较长时间间隔后复发的小体积rN1肿瘤是重新照射的可行候选者。然而,需要严格的患者选择和对颈动脉的细致护理。
