- 期刊
Value of Computed Tomography-Based Tumor Volume as a Predictor of Local Control in Oropharyngeal Cancer after Treatment of Definitive Radiotherapy
口咽癌病人治療前腫瘤體積對放射線治療後局部控制率的影響
摘要
目的：分析口咽癌病人治療前腫瘤體積，對放射線治療後局部控制率的影響。 材料與方法：本研究回溯性評估2002年1月到2006年12月期間接受放射線治療的65位口咽癌病人，其中扁桃窩(tonsillar fossa)有51位，軟顎(soft palate)有14位。所有的病人每天接受1.8 Gy的照射，總劑量達到68.4 Gy至78 Gy（劑量中位數70.2 Gy），其中54位病人也接受同步化學治療。本研究使用電腦斷層模擬攝影及放射治療計畫系統來分別描繪與計算原發腫瘤體積。統計方法以Kaplan-Meier來分析原興腫瘤控制率，再使用Cox's proportional hazard model來進行多變數分析。 結果：經過中位數26個月的追蹤（6至雙月）、T1和T2的病人之3年原發腫瘤控制率為90%，T3和T4的病人為46%（p值偽0.003）。量測的原發腫瘤體積平均為49.33毫升（3.17至242.59毫升）。當原發腫瘤體積＜30毫升時，3年原發腫瘤控制率為82%；而當原發腫瘤體積≧30毫升時，3年之原發腫瘤控制率為38%（p值為0.001）。多變數分析下顯示兩個較差的預後因子：原發腫瘤體積≧30毫升（p值為0007，危險比：6.6），和年齡≧50歲（p值為0000，危險比：10.6）。 結論：利用放射線治療之前的電腦斷層影像評估原發腫瘤的體積，可以更準確的預測口咽癌病人的局部控制率。當原發腫瘤體積大於30毫升時，會有較高的原發腫瘤復發的可能性。
並列摘要
Purpose: To investigate the value of pretreatment computed tomography (CT) volumetric analysis for the prediction of primary tumor control in patients with oropharyngeal cancer (OPC) treated by definite radiotherapy (RT), or concurrent chemoradiotherapy. Materials and Methods: From January 2002 through December 2006, 65 patients with OPC were enrolled for this retrospective analysis. The tonsillar fossa was the principal site in 51 cases, whereas the soft palate in 14 patients. All patients received daily dose of 1.8 Gy to a total dose of 68.4 Gy to 78 Gy (median; 70.2 Gy). Concurrent chemotherapy was given to 54 patients. Primary tumor volume (pGTV) was contoured using the CT simulation and the volume was calculated by the planning system. Primary tumor relapse-free survival (PRFS) was calculated using the Kaplan-Meier method, Multivariate analysis was performed using the Cox's proportional hazard model. Result: With a median follow-up of 26 months (range, 6-52 months), the 3 year PRFS was 90% for T1-2 disease and 46 % for T3-4 disease (p=0.003). The measured pGTV values ranged from 3.17 to 242.59 ml (mean, 49.33 ml). The 3 year PRFS was 82% for those with pGTV＜30 ml and 38% when pGTV were≧30 ml (p=0.001): Multivariate analysis of PRFS revealed two poor prognosis factor: pGTV≧30 ml (p=0.007, Hazard ratio: 6.6), and age≧50 years old (p=0.000, Hazard ratio: 10.6). Conclusion: Pretreatment CT-based primary tumor volumes are a strong predictor of local control for OPC treated by definitive RT. Primary tumor volumes≧30 ml are associated with higher relapse rate.
延伸閱讀
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