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1
題名:CLINICAL IMPLICATIONS OF TUMOR VOLUME IN PATIENTS WITH THE BASE OF TONGUE CANCER TREATED WITH DEFINITIVE INTENSITY-MODULATED RADIOTHERAPY TECHNIQUE     (24點)
舌根癌病人之腫瘤體積於強度調控放射治療的預後因子研究
著者:Shih-Chieh Lin(林士捷) ;Shih-Neng Yang(楊世能) ;Yao-Ching Wang(王耀慶) ;Ji-An Liang(梁基安) ;Yu-Cheng Kuo(郭于誠) ;Fang-Jen Lin(林芳仁) ;Shang-Wen Chen(陳尚文)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:舌根癌 ; 強度調控放射治療 ; 預後因子 ; 腫瘤體積 ; Base of tongue cancer ; Intensity-modulated radiotherapy technique ; Prognostic factor ; Tumor volume
刊名:Therapeutic Radiology and Oncology
頁碼:193-204
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

目的:探討舌根癌病人的腫瘤體積對於強度調控放射治療預後的影響。 材料與方法:回溯性分析從2003年到2009年期間,35位確診為臨床二至四期鱗狀上皮癌舌根癌且接受器官保留治療病人的病例紀錄。所有病人皆完成兩階段強度調控式放射線治療,每天接受之放射劑量為1.8Gy,原發腫瘤與轉移性淋巴結接受的總劑量之中位值為70.2Gy,預防性頸部淋巴的劑量之中位值為50.4Gy。其中的24位病人接受合併cisplatin之同步化學治療(cisplatin 80-100mg/m2,放療開始的第1、22、43天)。原發腫瘤體積之測量與計算分別取自放射治療前及治療期中之模擬攝影影像。 結果:經過中位值18個月的追蹤時間,24位病人(68.5%)被發現有原發腫瘤或頸部淋巴之局部復發。所有病人之兩年癌症相關存活率為24%,其中第二至三期病人的癌症相關存活率為25%,第四期病人之癌症相關存活率為9%(p=0.13)?另T2-T3腫瘤的兩年原發腫瘤無復發率為35%,而T4腫瘤的則降至0%(p=0.01)。原發腫瘤體積之中位值為34.6 mL(範圍,8.0至165mL),而治療中之原發腫瘤體積之中位值為9.4-19.4mL(範圍,3.8至79.3mL)。多變數分析發現原發腫瘤復發之不良預後因子為原發腫瘤體積大於20 mL(p=0.005,勝算比5.87,95%信賴區間1.29-26.7)與放療期中腫瘤體積降低比率小於0.4(p=0.002,勝算比3.74,95%信賴區間1.68~9.73)。 結論:本研究報告顯示強度調控治療對於施行器官保留術之舌根癌病人的治療成效並不理想,對於原發腫瘤體積大於20mL或放療期中腫瘤體積降低比率小於0.4的病人,必須考慮以更積極的治療方式來提高局部腫瘤的控制率,如提高局部放射治療劑量或是合併治療。
Purpose: To investigate the impact of tumor volume in patients with the base of tongue (BOT) cancer treated with definitive intensity-modulated radiotherapy technique (IMRT). Materials and Methods: From 2003 to 2009, 35 patients with stage II-IV squamous cell carcinoma of the BOT cancer receiving organ preservation scheme were enrolled in this retrospective analysis. Radiotherapy was performed using a sequential IMRT. All patients received 1.8 Gy daily up to a median total dose of 70.2Gy to gross tumors and metastatic lymph nodes, whereas the area harboring microscopic disease was prescribed with a median dose of 50.4 Gy. Twenty-four patients had concurrent chemotherapy. The regimen consisted of cisplatin(80-100mg/m2 on Days 1, 22, 43). Primary tumor volume measurement was derived using separate simulation images for the pretreatment gross tumor volume (pGTV) and the interval gross tumor volume (iGTV). Results: With a median follow-up duration of 18 months, 24 patients (68.5%) were found to have locoregional failures. The 2-year cause-specific survival was for all patients was 24%. The curve could be split into 25% for stage II-III disease, and 18% for stage IV disease (p=0.29). The 2-year primary relapse-free survival (PRFS) was 35 % for patients with T2-T3 disease, and the curve dropped to zero for patients with T4 disease (p= 0.01). The pGTV value ranged from 8.1 to 165 mL (median, 34.6 mL), whereas the iGTV ranged from 3.8 to 79.3 mL (median, 19.4 mL). Multivariate analysis showed that there were two predictors for the PRFS: pGTV≧20ml (p= 0.02, hazard ratio=5.87, 95% CI 1.29-26.72) and volume reduction rate (VRR)<0.4 (p=0.002, hazard ratio 4.33, 95% CI 1.71~10.99). Conclusions: This preliminary study shows that IMRT outcome in the BOT cancer patients was unsatisfactory. To optimize the treatment result, an aggressive treatment scheme should be considered for large pretreatment tumor burden or a VRR less than 0.4.


    

本卷期目次
Therapeutic Radiology and Oncology
ONCE-DAILY AND TWICE-DAILY RADIOTHERAPY WITHOUT CHEMOTHERAPY IN THE TREATMENT OF MALIGNANT GLIOMA/ Yu-Nong WangJing-Min HwangYee-Min JenChang-Min Chen
ELDERLY OROPHARYNX-HYPOPHARYNX CARCINOMA PATIENTS: INDUCTION CHEMOTHERAPY PLUS CHEMORADIOTHERAPY IMPROVE CANCER CONTROLS THAN RADIOTHERAPY ALONE/ Yao-Wen ChangMoon-Sing LeeShih-Kai HungWen-Yen ChiouWen-Lin HsuDai-Wei LiuYu-Chieh SuJing-Min HwangSzu-Chi LiHon-Yi Lin
CLINICAL IMPLICATIONS OF TUMOR VOLUME IN PATIENTS WITH THE BASE OF TONGUE CANCER TREATED WITH DEFINITIVE INTENSITY-MODULATED RADIOTHERAPY TECHNIQUE/ Shih-Chieh LinShih-Neng YangYao-Ching WangJi-An LiangYu-Cheng KuoFang-Jen LinShang-Wen Chen
LIMITED-STAGE SMALL CELL CARCINOMA OF ESOPHAGUS: A SINGLE INSTITUTION EXPERIENCE/ Forn-Chia LinLing-Wei WangMing-Wei YangSang-Hue Yen
UPDATE IN THE MANAGEMENT OF LOCALLY ADVANCED PANCREATIC CANCER-FOCUSING ON THE STRATEGY OF INDUCTION CHEMOTHERAPY FOLLOWED BY CHEMORADIOTHERAPY/ Hui-Ju Ch'angHelen Hw ChenLi-Tzong Chen
改善腫瘤微環境與放射敏感性的關係/ 王愈善季匡華
使用廣義等效均勻劑量(gEUD)為優化基礎的劑量體積目標之雙邊乳癌強度調控放射治療計劃/ 丁慧敏李財福趙珮如李曉飛黃英彥黃郁傑方富民卓明遠陳惠君
TOTAL BODY IRRADIATION WITH LATERAL TREATMENT TECHNIQUE USING WATER BAGS AS TISSUE COMPENSATORS/ Chu-Ping PiMu-Tai LiuTung-Hao ChangSheng-Shien HuangKuang-Hsuan Lin
CARCINOMA SHOWING THYMUS-LIKE DIFFERENTIATION (CASTLE) OF THE NECK: A CASE REPORT AND REVIEW OF THE LITERATURE/ Chia-Chun ChenWan-Lin ShenSung-Wei LiLi-Ching LinYu-Wen Wang
 
   
 
   

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