医学
头颈部癌
头颈部
放射治疗
癌症
放射科
核医学
肿瘤科
内科学
外科
作者
J.L. Huhn,W.F. Regine,Joseph Valentino,Ali S. Meigooni,M. Kudrimoti,Daniel E. Kenady,David Sloan,P SPRING,Majid Mohiuddin
标识
DOI:10.1016/s0360-3016(04)01762-6
摘要
Purpose/ObjectiveTo evaluate results of focal radiation dose escalation using a GRID technique in conjunction with conventional radiation for locally advanced SCCA of the head and neck.Materials/MethodsTwenty eight patients with previously untreated Stage IV (non-metastatic) head and neck primaries were treated with curative intent. Single fraction GRID doses of 1500–2000 cGy were added to a conventional course of definitive or pre-operative treatment. Treated neck stages were N2 (n = 4); N3 (n = 24). There were 23 male and 5 female patients whose median age was 61 years. Median tumor size was 8 cm. Follow up ranged from 3 to 102 months with a median of 16 months. Patients were evaluated for local response, long term control and toxicity. Two groups of patients were treated. In Group 1 (n = 15) patients with inoperable disease received conventional radiation doses of 54–79 Gy (median 70 Gy) plus the GRID treatment. In Group 2 (n = 13), all patients received a preoperative median neck dose of 59 Gy plus the GRID treatment followed by a planned ipsilateral neck dissection.ResultsNeck control for the entire group was 96%. There were no Grade 4 toxicities. In 14/15 (93%) patients in Group 1 the neck disease remained controlled until the most recent follow up or death. In Group 2, the pathologic complete response rate (pCR) was 85% (11/13) with an overall neck control rate of 100%. At the most recent follow up 8/13 (62%) of the group were NED (all of whom had achieved a pathologic complete response). Surgical toxicities were limited to 3 patients who had delayed wound healing. Overall 5 year survival for the entire group was 46% (13/28). Disease specific survival (DSS) for patients undergoing surgical resection was 79%. For the patients with inoperable disease DSS was 24%.ConclusionsGRID treatment may be safely added to conventional treatment management for advanced bulky neck disease associated with head and neck cancer. It may confer improved pathologic CR rate in patients undergoing planned neck dissection which is likely to yield an improved survival. In patients with inoperable disease, sustained long term local control is achievable Purpose/ObjectiveTo evaluate results of focal radiation dose escalation using a GRID technique in conjunction with conventional radiation for locally advanced SCCA of the head and neck. To evaluate results of focal radiation dose escalation using a GRID technique in conjunction with conventional radiation for locally advanced SCCA of the head and neck. Materials/MethodsTwenty eight patients with previously untreated Stage IV (non-metastatic) head and neck primaries were treated with curative intent. Single fraction GRID doses of 1500–2000 cGy were added to a conventional course of definitive or pre-operative treatment. Treated neck stages were N2 (n = 4); N3 (n = 24). There were 23 male and 5 female patients whose median age was 61 years. Median tumor size was 8 cm. Follow up ranged from 3 to 102 months with a median of 16 months. Patients were evaluated for local response, long term control and toxicity. Two groups of patients were treated. In Group 1 (n = 15) patients with inoperable disease received conventional radiation doses of 54–79 Gy (median 70 Gy) plus the GRID treatment. In Group 2 (n = 13), all patients received a preoperative median neck dose of 59 Gy plus the GRID treatment followed by a planned ipsilateral neck dissection. Twenty eight patients with previously untreated Stage IV (non-metastatic) head and neck primaries were treated with curative intent. Single fraction GRID doses of 1500–2000 cGy were added to a conventional course of definitive or pre-operative treatment. Treated neck stages were N2 (n = 4); N3 (n = 24). There were 23 male and 5 female patients whose median age was 61 years. Median tumor size was 8 cm. Follow up ranged from 3 to 102 months with a median of 16 months. Patients were evaluated for local response, long term control and toxicity. Two groups of patients were treated. In Group 1 (n = 15) patients with inoperable disease received conventional radiation doses of 54–79 Gy (median 70 Gy) plus the GRID treatment. In Group 2 (n = 13), all patients received a preoperative median neck dose of 59 Gy plus the GRID treatment followed by a planned ipsilateral neck dissection. ResultsNeck control for the entire group was 96%. There were no Grade 4 toxicities. In 14/15 (93%) patients in Group 1 the neck disease remained controlled until the most recent follow up or death. In Group 2, the pathologic complete response rate (pCR) was 85% (11/13) with an overall neck control rate of 100%. At the most recent follow up 8/13 (62%) of the group were NED (all of whom had achieved a pathologic complete response). Surgical toxicities were limited to 3 patients who had delayed wound healing. Overall 5 year survival for the entire group was 46% (13/28). Disease specific survival (DSS) for patients undergoing surgical resection was 79%. For the patients with inoperable disease DSS was 24%. Neck control for the entire group was 96%. There were no Grade 4 toxicities. In 14/15 (93%) patients in Group 1 the neck disease remained controlled until the most recent follow up or death. In Group 2, the pathologic complete response rate (pCR) was 85% (11/13) with an overall neck control rate of 100%. At the most recent follow up 8/13 (62%) of the group were NED (all of whom had achieved a pathologic complete response). Surgical toxicities were limited to 3 patients who had delayed wound healing. Overall 5 year survival for the entire group was 46% (13/28). Disease specific survival (DSS) for patients undergoing surgical resection was 79%. For the patients with inoperable disease DSS was 24%. ConclusionsGRID treatment may be safely added to conventional treatment management for advanced bulky neck disease associated with head and neck cancer. It may confer improved pathologic CR rate in patients undergoing planned neck dissection which is likely to yield an improved survival. In patients with inoperable disease, sustained long term local control is achievable GRID treatment may be safely added to conventional treatment management for advanced bulky neck disease associated with head and neck cancer. It may confer improved pathologic CR rate in patients undergoing planned neck dissection which is likely to yield an improved survival. In patients with inoperable disease, sustained long term local control is achievable
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