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| 腮腺癌术后不同区域放疗的靶区选择建议：一项回顾性结果分析 |
| Postoperative Radiotherapy Target Volume Selection for Parotid Gland Cancer: A Retrospective Outcome Analysis |
| 投稿时间：2025-04-15 修订日期：2025-08-14 |
| DOI： |
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| 中文关键词: 腮腺癌 术后放疗 靶区勾画 控制结果 |
| 英文关键词:Parotid Gland Cancer Postoperative radiotherapy Target delineation Control results |
| 基金项目: |
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| 摘要点击次数: 263 |
| 全文下载次数: 8 |
| 中文摘要: |
| 目的 通过观察腮腺癌术后不同区域预防性照射后的控制情况及生存结果,进一步指导临床医生选择合适的区域进行放疗。方法 本研究回顾性的收集了2013年1月至2021年12月在江苏省肿瘤医院接受术后放疗的腮腺肿瘤患者。排除患有其他肿瘤、远处转移行局部姑息性放疗以及腮腺良性肿瘤。通过瓦里安系统调阅靶区,影像学随访观察靶区复发情况,采用Kaplan-Meier方法进行生存分析,并采用Cox比例风险回归模型来评估生存结果。结果 本研究共纳入180名腮腺恶性肿瘤患者,通过不同的放疗区域分为照射淋巴引流区(颈部)组与未照射组、照射乳突组与未照射组、照射海绵窦组与未照射组(组别之间相互独立)。所有患者总共有37例出现不同部位的疾病进展；照射颈部组与未照射组颈部淋巴引流区分别有9例和2例疾病进展(包括合并远处转移)。照射乳突组与未照射组中,照射组有1例乳突部位进展。照射海绵窦组与未照射组均无海绵窦部位进展。所有患者3年、5年的PFS率分别为81.2%、76.7%,OS率分别为88.7%、86.8%。照射颈部组与未照射组5年无进展生存率为76.1%和80.5%(P=0.791)；照射乳突/海绵窦组与未照射组5年PFS率为(65.6% vs 81.5%,P=0.057；55.6% vs 78.7%,P=0.097)；p/cN0患者均显示T3-4期为不良预后因素；N+的患者均接受了不同区域的颈部放疗,T4期和腺样囊性癌患者在照射乳突/海绵窦组与未照射组均未发现乳突和海绵窦的复发。多因素分析中,女性、T晚期与所有患者的OS相关；女性、年龄＞48岁、T晚期、N+与PFS相关。结论 T晚期或腺样囊性癌等患者应慎重选择乳突和海绵窦照射。T1-2期N0患者建议仅对瘤床进行放疗,女性、年龄较大、T3-4等因素N0患者建议颈部淋巴引流区域放疗。 |
| 英文摘要: |
| Objective This study aims to guide clinicians in selecting appropriate regions for radiotherapy by evaluating the control outcomes and survival results following postoperative preventive irradiation in different regions for parotid gland cancer.Methods This retrospective study collected data from patients with parotid gland tumors who received postoperative radiotherapy at Jiangsu Cancer Hospital from January 2013 to December 2021. Patients with other malignancies, distant metastases, who underwent palliative local radiotherapy, or who had benign parotid tumors were excluded.Target volumes were delineated using the Varian system, with radiological follow-up to assess recurrence in the target areas. Survival analysis was performed using the Kaplan-Meier method, and the Cox proportional hazards regression model was applied to evaluate survival outcomes.Results A total of 180 patients with parotid cancer were included in this study. Based on different radiation fields, patients were divided into groups receiving radiation to the lymphatic drainage region (neck) versus non-irradiated group, mastoid region versus non-irradiated group, and cavernous sinus region versus non-irradiated group (the groups were independent of each other).A total of 37 patients experienced disease progression at different sites. In the neck irradiation group, 9 cases of disease progression occurred within the cervical lymphatic drainage area (including cases with distant metastasis), compared to 2 cases in the non-irradiation group. In the group irradiated to the mastoid, 1 case of progression at the mastoid site was observed, whereas no progression was noted in the mastoid region of the non-irradiation group. No disease progression occurred in the cavernous sinus region in either the irradiated or non-irradiated groups. The 3-year and 5-year progression-free survival (PFS) rates for all patients were 81.2% and 76.7%, while the overall survival (OS) rates were 88.7% and 86.8%. In the neck irradiation group, the 5-year PFS rate was 76.1%, compared to 80.5% in the non-irradiation group (P=0.791)；the 5-year PFS rates were 65.6% versus 81.5% (P=0.057) and 55.6% versus 78.7% (P=0.097) in the irradiated the mastoid/cavernous sinus and non-irradiated groups, respectively.Patients with p/cN0 status demonstrated that T3-4stage was an adverse prognostic factor. All N+patients received regional cervical irradiation, and no recurrence in the mastoid or cavernous sinus was observed in T4stage or adenoid cystic carcinoma patients, whether irradiated to the mastoid/cavernous sinus or not. In the multivariate analysis, female gender, advanced T stage were associated with OS for all patients, while female gender, age >48 years, advanced T stage, and N+status were found to be associated with PFS.Conclusions Patients with advanced T stage or adenoid cystic carcinoma should undergo cautious consideration regarding irradiation of the mastoid and cavernous sinus. For T1-2N0patients, it is recommended to administer radiotherapy only to the tumor bed. In contrast, for N0 patients with factors such as female gender, older age, and advanced T stage (T3-4), irradiation of the cervical lymphatic drainage areas is suggested. |
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