글로벌 연구동향
핵의학
- 2020년 11월호
[Head Neck.] Reirradiation with intensity-modulated radiation therapy for recurrent or secondary head and neck cancer: Meta-analysis and systematic review고려의대 / 이정심, 임채홍*
- 출처
- Head Neck.
- 등재일
- 2020 Sep
- 저널이슈번호
- 42(9):2473-2485. doi: 10.1002/hed.26264. Epub 2020 May 21.
- 내용
Abstract
Background: To summarize outcomes of reirradiation with intensity-modulated radiotherapy (IMRT) for recurrent or secondary head and neck cancer (HNC).Methods: Primary endpoints were 2-year local control (LC) and overall survival (OS). Studies involving only recurrent nasopharyngeal patients with cancer were excluded.
Results: A total of 17 studies involving 1635 patients were included. Fourteen (82%) of those were retrospective, and 15 (88%) were from single institution. Reirradiation with IMRT produced pooled 2-year LC and OS rates of 52% (95% confidence interval [CI], 46%-57%) and 46% (95% CI, 41%-50%), respectively. In subgroup analyses, the rate of salvage surgery (<42% vs ≥42%) influenced the pooled 2-year LC rate (45.9% vs 58.5%, P = .011). The pooled rates of late grade ≥ 3 and grade 5 toxicities were 26% (95% CI, 20%-32%) and 3.1% (95% CI, 2%-5%), respectively.
Conclusions: Reirradiation with IMRT was an effective modality compared to historical outcomes in the pre-IMRT era.
Affiliations
Jeongshim Lee 1 2 , In-Soo Shin 3 , Woo Chul Kim 1 , Won Sup Yoon 4 , Woong Sub Koom 2 , Chai Hong Rim 4
1 Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea.
2 Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea.
3 Graduate School of Education, Dongguk University, Seoul, South Korea.
4 Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan, South Korea.
- 키워드
- head and neck cancer; intensity-modulated radiotherapy; meta-analysis; recurrence; reirradiation.
- 연구소개
- 중기 이후의 암은 상당수가 재발하고 재발한 이후에는 기대 여명이 상대적으로 낮으므로 수술보다 비침습적인 방사선치료의 역할이 중요합니다. 그러나 re-irradiation 에 대해서는 방사선독성의 누적 가능성 및 임상 부작용 위험성으로 인해 연구가 부족합니다. 본 메타분석에서는 17개 연구, 1635명의 환자의 자료를 통합하여 두경부암 환자에게 시행된 IMRT re-irradiation의 결과를 분석하였고, 2년 국소제어율 및 생존율 52%, 46%로 이전 3DCRT시대 (2년생존율 15-25%)에 비해 크게 향상되었습니다. 부작용또한 감소하였지만 3등급 이상의 부작용이 26%, 치명률 3%로 carotid sparing등 부작용을 최소화하기 위한 노력은 계속 필요하겠습니다.
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