PDF(Pubmed)
Abstract：
Purpose This study examines the outcomes of locally advanced head and neck squamous cell carcinoma (HNSCC) following the adoption of conventional intensity-modulated radiotherapy (cIMRT) and volumetric-modulated arc therapy (VMAT) over a decade. The region under study has higher comorbidities associated with increased HNSCC incidence and poorer prognosis. Materials and methods A 10-year retrospective review of electronic medical records included 296 patients with stage III, IVA, and IVB HNSCC (American Joint Committee on Cancer, Seventh edition). Survival outcomes were compared between VMAT and cIMRT using Kaplan-Meier survival curves and adjusted for relevant demographic factors using Cox\'s proportional hazards model. Analysis was performed using R software (R Foundation, Vienna, Austria). Results The median age of the cohort was 63 years, comprising of 80% males. The oropharynx was the most common primary tumor site. 264 (89%) received 50Gy or higher dose radiation by either cIMRT (22%) or VMAT (67%). At five years, locoregional control (LC) and overall survival (OS) rates were 79.5% and 56.7%, respectively. VMAT showed a significant improvement in five-year OS (63.4% versus 43.8% for cIMRT, p=0.0023) but no significant difference in five-year LC (81% VMAT versus 74.5% cIMRT, p=0.17). Grade 3-4 acute toxicity was observed in 22% of patients. Conclusions VMAT and cIMRT demonstrated excellent LC in locally advanced HNSCC despite high comorbidity rates. Notably, VMAT was associated with significantly better OS compared to cIMRT. These outcomes surpass historical data, suggesting that VMAT technology may lead to improved patient outcomes. However, larger randomized controlled trials and dosimetric studies are needed to confirm these findings.
摘要：
目的本研究探讨了十年来采用常规调强放疗（cIMRT）和体积调强电弧疗法（VMAT）后局部晚期头颈部鳞状细胞癌（HNSCC）的结果。研究区域的合并症较高，与HNSCC发病率增加和预后较差相关。材料与方法对电子病历进行了10年的回顾性回顾，包括296例III期患者，IVA,和IVBHNSCC(美国癌症联合委员会，第七版）。使用Kaplan-Meier生存曲线比较VMAT和cIMRT之间的生存结果，并使用Cox比例风险模型校正相关人口统计学因素。使用R软件进行分析(RFoundation，维也纳,奥地利)。结果该队列的中位年龄为63岁，包括80%的男性。口咽是最常见的原发肿瘤部位。264（89％）接受了cIMRT（22％）或VMAT（67％）的50Gy或更高剂量的辐射。五年后，局部区域控制率（LC）和总生存率（OS）分别为79.5%和56.7%，分别。VMAT在五年OS方面表现出显着改善（cIMRT为63.4％，而cIMRT为43.8％，p=0.0023），但在五年LC中没有显着差异（81%VMAT与74.5%cIMRT，p=0.17）。在22％的患者中观察到3-4级急性毒性。结论尽管合并症发生率较高，但VMAT和cIMRT在局部晚期HNSCC中表现出优异的LC。值得注意的是,与cIMRT相比，VMAT与明显更好的OS相关。这些结果超过了历史数据，这表明VMAT技术可能会改善患者的预后。然而,需要更大规模的随机对照试验和剂量学研究来证实这些发现.
