UNASSIGNED:同侧颈部放疗(RT)在一些扁桃体癌患者中存在争议,原因是担心对侧未照射颈部的淋巴结衰竭(以下称为对侧颈部衰竭[CNF])。
UNASSIGNED:确定扁桃体癌患者同侧颈部RT后CNF的发生率。
UNASSIGNED:包括PubMed、Embase,WebofScience,和Cochrane图书馆被查询为同行评审,1980年1月1日至2021年12月31日之间发表的英语文章。
UNASSIGNED:研究报告了至少20例接受同侧颈部RT治疗的患者的CNF发生率。如果缺乏全文,研究被排除在外,从数据库或系统评价报告的结果,或未提供RT详细信息。
未经评估:按照PRISMA报告指南提取数据。使用非随机研究的方法学指标标准评估研究质量。使用随机效应模型估计汇集的结果。
UNASSIGNED:主要结果是同侧颈部RT后CNF的合并率。次要结局是第7版AJCC癌症分期手册中按肿瘤和淋巴结分期分类的CNF合并率和毒性作用率。
UNASSIGNED:共17项研究(16项回顾性研究和1项前瞻性研究),包括1487例独特患者。CNF的合并风险为1.9%(95%CI,1.2%-2.6%)。按肿瘤(T)类别划分的CNF率如下:T1为1.3%(95%CI,0.3%-2.3%);T2为3.0%(95%CI,1.6%-4.4%);T3为11.3%(95%CI,3.3%-19.2%);T4为16.0%(95%CI,-7.8%至39.8%)。T3至T4肿瘤患者的CNF发生率明显高于T1至T2肿瘤患者(11.5%[95%CI,3.9%-19.1%]vs1.8%[95%CI,1.0%-2.6%];P<.001)。按节点(N)分类的CNF率为N0为1.2%(95%CI,0.1%-2.2%);N1为4.8%(95%CI,2.4%-7.2%);N2a为3.1%(95%CI,0.4%-5.8%);N2b为3.1%(95%CI,1.2%-4.9%);N3为0(95%CI,不适用)。N2b至N3和N0至N2a病患者的CNF发生率相似(3.0%[95%CI,1.2%-4.7%]vs1.7%[95%CI,0.6%-2.8%],分别;P=0.07)。与双侧RT相比,同侧RT与CNF风险增加相关(对数比值比,1.29[95%CI,0.09-2.48];P=.04)。3级或更高的口干症和饲管使用的粗发生率为0.9%(95%CI,-0.2%至1.9%)和13.3%(95%CI,8.3%-18.3%),分别。
未经评估:在本系统综述和荟萃分析中,同侧颈部RT与小患者的低CNF发生率相关,侧向扁桃体癌。与同侧颈部RT相比,双侧颈部RT与CNF的风险较低相关。具有较高T类别肿瘤的患者在同侧颈部RT后CNF的风险增加,晚期淋巴结分期与CNF无关。在同侧颈部RT治疗的患者中,毒性作用的发生率似乎很好。
Ipsilateral neck radiotherapy (RT) is controversial in some patients with tonsil cancer due to concern for nodal failure within the contralateral nonirradiated neck (hereinafter referred to as contralateral neck failure [CNF]).
To determine the rate of CNF following ipsilateral neck RT in patients with tonsil cancer.
Databases including PubMed, Embase, Web of Science, and Cochrane Library were queried for peer-reviewed, English language articles published between January 1, 1980, and December 31, 2021.
Studies reporting rates of CNF from at least 20 patients treated with ipsilateral neck RT. Studies were excluded if they lacked full text, reported results from databases or systematic reviews, or did not provide RT details.
Data were extracted following the PRISMA reporting guideline. Study quality was assessed using criteria from a methodological index for nonrandomized studies. Pooled outcomes were estimated using random-effects models.
Primary outcome was the pooled rate of CNF following ipsilateral neck RT. Secondary outcomes were the pooled rates of CNF by tumor and nodal staging categories from the 7th edition of the AJCC Cancer Staging Manual and rates of toxic effects.
A total of 17 studies (16 retrospective and 1 prospective) including 1487 unique patients were identified. The pooled risk of CNF was 1.9% (95% CI, 1.2%-2.6%). The rate of CNF by tumor (T) category was as follows: 1.3% (95% CI, 0.3%-2.3%) for T1; 3.0% (95% CI, 1.6%-4.4%) for T2; 11.3% (95% CI, 3.3%-19.2%) for T3; and 16.0% (95% CI, -7.8% to 39.8%) for T4. Patients with T3 to T4 tumors had a significantly higher rate of CNF than those with T1 to T2 tumors (11.5% [95% CI, 3.9%-19.1%] vs 1.8% [95% CI, 1.0%-2.6%]; P < .001). The rate of CNF by nodal (N) category was 1.2% (95% CI, 0.1%-2.2%) for N0; 4.8% (95% CI, 2.4%-7.2%) for N1; 3.1% (95% CI, 0.4%-5.8%) for N2a; 3.1% (95% CI, 1.2%-4.9%) for N2b; and 0 (95% CI, not applicable) for N3. Rates of CNF were similar for patients with N2b to N3 and N0 to N2a disease (3.0% [95% CI, 1.2%-4.7%] vs 1.7% [95% CI, 0.6%-2.8%], respectively; P = .07). Compared with bilateral RT, ipsilateral RT was associated with increased risk of CNF (log odds ratio, 1.29 [95% CI, 0.09-2.48]; P = .04). The crude rates of xerostomia of grade 3 or greater and feeding tube use were 0.9% (95% CI, -0.2% to 1.9%) and 13.3% (95% CI, 8.3%-18.3%), respectively.
In this systematic
review and meta-analysis, ipsilateral neck RT was associated with a low rate of CNF in patients with small, lateralized tonsil cancers. Bilateral neck RT was associated with lower risk of CNF compared with ipsilateral neck RT. Patients with tumors of a higher T category were at increased risk for CNF following ipsilateral neck RT, and advanced nodal stage was not associated with CNF. Rates of toxic effects appeared favorable in patients treated with ipsilateral neck RT.