局限野调强放疗治疗甲状腺乳头状癌局部术后残留的疗效及复发模式分析  

Analysis of the efficacy and recurrence pattern of post-operative limited-field intensity-modulated radiotherapy in papillary thyroid cancer patients with locoregionally residual disease

作　　者：欧丹[1,4,5,6] 李申箎 官青 薛芬 牛小爽 嵇庆海 何霞云 Ou Dan;Li shenchi;Guan Qing;Xue Fen;Niu Xiaoshuang;Ji Qinghai;He Xiayun(Department of Radiation Oncology,Fudan University Shanghai Cancer Center,Shanghai 200032,China;Department of Oncology,Shanghai Deltahealth Hospital,Shanghai 201702,China;Department of Head and Neck Surgery,Fudan University Shanghai Cancer Center,Shanghai 200032,China;Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China;Shanghai Clinical Research Center for Radiation Oncology,Shanghai 200032,China;Shanghai Key Laboratory of Radiation Oncology,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院放射治疗中心,上海200032 [2]上海德达医院肿瘤中心,上海201702 [3]复旦大学附属肿瘤医院头颈外科,上海200032 [4]复旦大学上海医学院肿瘤学系,上海200032 [5]上海市放射治疗临床医学研究中心,上海200032 [6]上海市放射肿瘤学重点实验室,上海200032

出　　处：《中华转移性肿瘤杂志》2023年第3期213-218,共6页Chinese Journal of Metastatic Cancer

基　　金：上海市临床重点专科项目(2018)。

摘　　要：目的评估局部术后残留的局部晚期或复发甲状腺乳头状癌(PTC)接受局限野调强放疗(IMRT)的疗效、不良反应及复发模式。方法回顾性分析2012年10月至2019年5月期间复旦大学附属肿瘤医院放射治疗中心收治的接受术后IMRT的54例局部晚期或复发的PTC患者的临床病理资料。仅有原发灶局部残留的患者, 行局限野放疗, 不常规行颈部淋巴结引流区照射。结果中位随访时间82.3个月, 所有患者对IMRT耐受性良好。IMRT相关急性不良反应主要为1~2级, 仅1例发生3级放射性皮炎。8年局部区域无进展生存率(LPFS)和总生存(OS)率分别为 83%和90%。接受局限野IMRT患者中2例(4%)出现孤立的放疗野外淋巴结复发。结论局限野IMRT治疗局部晚期或复发PTC仅有局部术后残留患者可获得持久的LPFS和OS, 放疗野外复发少见, 可为相关临床治疗提供一定参考, 值得进一步探索。Objective To evaluate the efficacy,toxicity and the pattern of relapse associated with limited-field intensity-modulated radiotherapy(IMRT)for locoregionally advanced or recurrent papillary thyroid cancer(PTC)with residual disease.Methods From October 2012 to May 2019,a retrospective analysis was conducted in 54 patients with locoregionally advanced or recurrent PTC treated with post-operative IMRT to the primary site with residual disease.For patients with local-only residual disease,the limited-field IMRT was administered.Elective lateral neck lymph node regions were not routinely irradiated.Results The median follow-up was 82.3 months.All patients tolerated radiotherapy well.The acute adverse reactions associated with IMRT were mainly grade 1 to grade 2,and only 1 case had grade 3 radiation dermatitis.The estimated locoregional progression-free survival(LPFS)rate was 83%at 8 years.The estimated 8-year overall survival(OS)rate was 90%.Only 2(4%)patients developed an isolated out-of-field nodal recurrence after limited-field RT.Conclusions Post-operative limited-field IMRT provides durable LPFS and OS and low toxicity for patients with advanced or recurrent PTC with local-only residual disease.Out-of-field regional recurrence was rare.Further larger scaled study is warranted.

关 键 词：甲状腺乳头状癌 调强放射治疗 预后 不良反应 

分 类 号：R736.1[医药卫生—肿瘤] R730.55[医药卫生—临床医学]