■患有宫颈转移的未知原发性鳞状细胞癌(CUP)的患者通常会接受咽部和双侧颈部的综合放疗(RT)。通常,这些患者接受咽部和双侧颈部的全面RT,可能产生治疗相关的毒性作用.
■确定经口机器人手术(TORS)结合减少的咽部和颈部RT量对隐匿性口咽癌的定位是否可提供可接受的疾病控制。
■这项在单一机构进行的2期单组非随机对照试验在2017年至2019年的检查和影像学检查中累积了32名p16阳性CUP无原发性鳞状细胞癌的前瞻性参与者,以及24个月的随访。数据分析于2021年1月至2022年6月进行。
■诊断(n=13)或治疗意图(n=9)TORS,对于切缘阴性或pT0,使用咽部保留放疗(PSRT),对于单侧淋巴结肿大伴原发性肿瘤或pT0,使用单侧颈部RT(UNRT)。
■放射治疗容量失效(假设<15%是可以接受的)以及局部和区域复发的报告,总生存率,毒性作用,吞咽结果(根据MD安德森吞咽困难清单),和视频透视吞咽(根据吞咽毒性效应的动态成像等级[摘要])评级。
■研究样本包括22名患者(平均[SD]年龄,59.1[5.7]岁;女性3[14%],男性19[86%])患有CUP。其中,19例(86%)肿瘤分期为cN1;2例(9%),cN2;和1(5%),cN3.5名患者(23%),14名患者(64%),3例患者(13%)有0、1或2个原发肿瘤,分别。20名患者接受了RT;其中,9例(45%)患者行PSRT,10例(50%)患者行PSRT,UNRT.在诊断意图组中,8例患者(62%)和5例患者(38%)接受RT和RT同步化疗,分别。在治疗意向组中,6例患者(67%)和1例患者(11%)接受辅助RT同步化疗,分别为2例患者拒绝RT。两年无放射治疗量失败,局部控制,远处转移控制,总生存率为0%,100%,95%,100%,分别。3级或4级手术,急性,晚期毒性作用发生在2例(9%)中,5(23%),1名(5%)患者,分别。PSRT与较低的RT剂量到上收缩器相关(37vs53Gy;平均差,16Gy;95%CI,6.4,24.9),治疗期间吞咽评分下降较小(19.3vs39.7;平均差,-20.4;95%CI,-34.1至-6.1),和较少的患者恶化DIGEST等级在2年的视频透视吞咽研究的结果(0%vs60%;差异,60%;95%CI,30%至90%)。
■这些研究结果表明,p16阳性CUP的TORS可以降低RT容量,具有出色的结果,并支持随机临床试验的未来研究。
■ClinicalTrials.gov标识符:NCT03281499。
UNASSIGNED: Patients with unknown primary squamous cell carcinoma (CUP) with cervical metastases typically receive comprehensive radiotherapy (RT) of the pharynx and bilateral neck. Typically, these patients receive comprehensive RT of the pharynx and bilateral neck that may produce treatment-related toxic effects.
UNASSIGNED: To determine whether localization of occult oropharyngeal cancers with transoral robotic surgery (TORS) combined with reduced pharyngeal and neck RT volumes provides acceptable disease control.
UNASSIGNED: This phase 2, single-group nonrandomized controlled
trial at a single institution accrued 32 prospective participants with p16-positive CUP without a primary squamous cell carcinoma on examination and imaging from 2017 to 2019, and 24-month follow-up. The data analysis was conducted from January 2021 to June 2022.
UNASSIGNED: Diagnostic- (n = 13) or therapeutic-intent (n = 9) TORS, with pharyngeal-sparing radiotherapy (PSRT) prescribed for negative margins or pT0, and unilateral neck RT (UNRT) prescribed for unilateral lymphadenopathy with lateralized primary tumor or pT0.
UNASSIGNED: Out-of-radiation treatment volume failure (<15% was hypothesized to be acceptable) and reports of local and regional recurrence, overall survival, toxic effects, swallowing outcomes (per the MD Anderson Dysphagia Inventory), and videofluoroscopic swallow (per Dynamic Imaging Grade of Swallowing Toxic Effects [DIGEST]) ratings.
UNASSIGNED: The
study sample comprised 22 patients (mean [SD] age, 59.1 [5.7] years; 3 [14%] females and 19 [86%] male) with CUP. Of these, 19 patients (86%) had tumor stage cN1; 2 (9%), cN2; and 1 (5%), cN3. Five patients (23%), 14 patients (64%), and 3 patients (13%) had 0, 1, or 2 primary tumors, respectively. Twenty patients received RT; of these, 9 patients (45%) underwent PSRT and 10 patients (50%), UNRT. In the diagnostic-intent group, 8 patients (62%) and 5 patients (38%) underwent RT and RT-concurrent chemotherapy, respectively. In the therapeutic-intent group, 6 patients (67%) and 1 patient (11%) received adjuvant RT-concurrent chemotherapy, respectively; 2 patients declined RT. Two-year out-of-radiation treatment volume failure, locoregional control, distant metastasis control, and overall survival were 0%, 100%, 95%, and 100%, respectively. Grade 3 or 4 surgical, acute, and late toxic effects occurred in 2 (9%), 5 (23%), and 1 (5%) patients, respectively. PSRT was associated with lower RT dose to superior constrictors (37 vs 53 Gy; mean difference, 16 Gy; 95% CI, 6.4, 24.9), smaller decline in swallowing scores during treatment (19.3 vs 39.7; mean difference, -20.4; 95% CI, -34.1 to -6.1), and fewer patients with worsening DIGEST grade on findings of videofluoroscopic swallow studies at 2 years (0% vs 60%; difference, 60%; 95% CI, 30% to 90%).
UNASSIGNED: These findings indicate that TORS for p16-positive CUP allows RT volume deintensification with excellent outcomes and support future investigation in randomized clinical trials.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT03281499.