口腔鳞状细胞癌的最终放射治疗：系统回顾和汇总分析

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-01 DOI:10.1016/S0167-8140(25)04761-9

Emmanuel Akingbade , Aquila Akingbade , Andrea Vucetic , Anthony Luginaah , Matthew Van Oirschot , Lydia Abraha , Ella Rival , Andrew Youssef , Christopher Goodman , Adam Mutsaers

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引用次数: 0

摘要

目的：手术是口腔（OC）鳞状细胞癌（OC- scc）的标准护理。有些病人不适合或拒绝标准治疗。明确放疗（dRT）是另一种选择，但技术和结果是不同的。进行系统评价和汇总分析以综合现有证据。材料和方法：检索PubMed、EMBASE和Cochrane数据库，从建立到2023年10月，以评估dRT治疗OC-SCC的研究。纳入了明确意向治疗或EQD2≥60 Gy治疗的研究。没有定量终点或特定于OC亚组数据的研究被排除在外。本分析排除了近距离放射治疗研究。提取1年和5年局部对照（LC1,5）、总生存期（OS1,5）和分级毒性的数据。计算加权平均值和标准差（wSD）。结果：在5584项研究中，86项研究符合纳入标准。研究纳入了1962年至2020年的患者，其中19篇论文纳入了2005年以后专门治疗的患者。10项研究使用3d适形RT， 16项研究使用强度调制RT，其余研究使用2D或混合技术。大多数研究为回顾性研究（n=55）和单中心研究（n=66）。诱导或同步化疗分别在18.6% （n=16）和65.1% （n=56）的研究中进行。中位EQD2为68.5 Gy（范围50-74 Gy）。LC1为66.4% （wSD: 20.1%， 16项研究报道），LC5为61.6% （wSD: 18.1%， 23项研究报道）。OS1为70.1% （wSD: 12.1%， 55项研究），OS5为34.5% （wSD: 15.9%， 60项研究）。52项研究报告了毒性。皮炎、吞咽困难和粘膜炎的急性3+级毒性合并发生率分别为14.6%、23.6%和43.8%。晚期3+级吞咽困难占11.4%。7.8%的患者发现2+级骨放射性坏死（范围：0-28%）。没有5级毒性的报道。结论：在这个庞大的异质队列中，持久的局部控制在可接受的毒性下是可以实现的。该分析支持dRT作为拒绝或不适合切除的c - scc患者的有效选择。未来的分析将包括亚组的定量结果（肿瘤亚位点、放射技术、肿瘤t期、整体分期、全身治疗等），并了解失败的模式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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DEFINITIVE RADIOTHERAPY FOR SQUAMOUS CELL CARCINOMAS OF THE ORAL CAVITY: A SYSTEMATIC REVIEW AND POOLED ANALYSIS

Purpose:

Surgery is the standard of care for oral cavity (OC) squamous cell carcinoma (OC-SCC). Some patients are unfit for or refuse standard therapy. Definitive radiotherapy (dRT) is an alternative option, but techniques and outcomes are heterogeneous. Systematic review and pooled analyses were undertaken to synthesize available evidence.

Materials and Methods:

PubMed, EMBASE, and Cochrane databases were queried from inception to October 2023 for studies evaluating dRT for OC-SCC. Studies which specified definitive intent treatment or treated with EQD2 ≥60 Gy were included. Studies without quantitative endpoints or data specific to OC subgroups were excluded. Brachytherapy studies were excluded in present analysis. Data on 1 and 5-year local control (LC1,5), overall survival (OS1,5) and graded toxicities were extracted. Weighted means and standard deviations (wSD) were calculated.

Results:

Of 5584 studies, 86 studies met inclusion criteria. Studies included patients from 1962 to 2020, with 19 papers including patients treated exclusively after 2005. Ten studies used 3D-conformal RT, 16 used intensity modulated RT, and the remainder utilized 2D or mixed techniques. Most studies were retrospective (n=55) and single centre (n=66). Induction or concurrent chemotherapy was delivered in 18.6% (n=16) and 65.1% (n=56) of studies, respectively. Median EQD2 was 68.5 Gy (range 50-74 Gy). LC1 was 66.4% (wSD: 20.1%, reported in 16 studies), and LC5 was 61.6% (wSD: 18.1%, 23 studies). OS1 was 70.1% (wSD: 12.1%, 55 studies), and OS5 was 34.5% (wSD: 15.9%%, 60 studies). Toxicity was reported in 52 studies. Pooled rates of acute Grade 3+ toxicity for dermatitis, dysphagia, and mucositis were 14.6%, 23.6%, and 43.8%, respectively. Rate of late Grade 3+ dysphagia was 11.4%. Grade 2+ osteoradionecrosis was identified in 7.8% of patients (range: 0-28%). There were no Grade 5 toxicities reported.

Conclusions:

In this large, heterogeneous cohort, durable local control was attainable with acceptable toxicity. This analysis supports dRT as a useful alternative in OC-SCC patients who refuse or are not candidates for resection. Future analyses will include quantitative outcomes by subgroups (OC subsite, radiation technique, tumour T-stage, overall stage, systemic therapy, etc.) and understanding patterns of failure.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.