Jane Y Tong, Vera Bzhilyanskaya, Matthew J Ferris, Jason K Molitoris, Kyle M Hatten
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引用次数: 0
Abstract
Objective: Advances in the treatment of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) include transoral robotic surgery (TORS) and proton beam therapy (PBT). This study aims to improve understanding of the treatment toxicities associated with adjuvant PBT following TORS for OPSCC.
Study design: A retrospective review.
Setting: An academic tertiary care center in Baltimore, Maryland.
Methods: Patients undergoing TORS followed by adjuvant PBT from 2017 to 2023 were reviewed.
Results: Forty-seven patients with HPV-associated OPSCC underwent TORS followed by adjuvant PBT. Forty-one (87.2%) patients were male. The median age at first radiation fraction was 61.7 years. Forty-one (87.2%) identified as white and 6 (12.8%) as African American. Most patients had T1 (23 [48.9%]) or T2 (22 [46.8%]), N1 (41 [87.2%]) disease. The majority (98.3%) of acute toxicities were grade 1 or 2, with only 1 (2.1%) patient developing grade 3 toxicities. Three (6.4%) patients required a feeding tube for nutrition during adjuvant proton radiation treatment. The 3 patients who required feeding tubes during radiation also required postoperative nasogastric tubes for a median of 16 days, compared with 3 days for all other patients (Mann-Whitney U, P = .02). The most common chronic toxicities included xerostomia, dysphagia, dysgeusia, and lymphedema, which decreased over time.
Conclusion: HPV-associated OPSCC treated with TORS followed by adjuvant PBT demonstrated a favorable toxicity profile with mostly grade 1 or 2 acute toxicities. Feeding tube requirement during adjuvant PBT was low at 6.4%. Many chronic toxicities appeared to decrease in frequency with time from radiation, although further study is required.
目的：人乳头瘤病毒（HPV）相关口咽鳞状细胞癌（OPSCC）的治疗进展包括经口机器人手术（TORS）和质子束治疗（PBT）。本研究旨在提高对OPSCC TORS后辅助性PBT治疗毒性的认识。研究设计：回顾性研究。环境：马里兰州巴尔的摩的一个学术三级护理中心。方法：回顾2017年至2023年接受tor后辅助PBT的患者。结果：47例hpv相关的OPSCC患者接受了tor和辅助PBT。男性41例（87.2%）。首次放疗时的中位年龄为61.7岁。41人（87.2%）是白人，6人（12.8%）是非裔美国人。多数患者为T1（23例[48.9%]）或T2(22例[46.8%]),N1（41例[87.2%]）。大多数（98.3%）急性毒性为1级或2级，只有1例（2.1%）患者出现3级毒性。3例（6.4%）患者在辅助质子放射治疗期间需要饲管进行营养。放疗期间需要饲管的3例患者术后也需要鼻胃管，中位时间为16天，而其他所有患者为3天（Mann-Whitney U, P = 0.02）。最常见的慢性毒性包括口干、吞咽困难、发音困难和淋巴水肿，随着时间的推移而减少。结论：用tor治疗hpv相关的OPSCC，再辅以PBT治疗，显示出良好的毒性，主要是1级或2级急性毒性。辅助PBT期间饲管需要量低，为6.4%。许多慢性毒性似乎随着受辐射时间的延长而减少，尽管还需要进一步的研究。
期刊介绍：
Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.
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