| 刘迎新,姜雪松,李雨桃,等.腮腺癌术后不同区域放疗的靶区选择建议：基于180例患者的回顾性分析[J].肿瘤学杂志,2025,31(12):1069-1076. |
| 腮腺癌术后不同区域放疗的靶区选择建议：基于180例患者的回顾性分析 |
| Postoperative Radiotherapy Target Volume Selection in Different Regions for Parotid Gland Cancer： Retrospective Analysis Based on 180 Patients |
| 投稿时间：2025-04-15 |
| DOI：10.11735/j.issn.1671-170X.2025.12.B010 |
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| 中文关键词: 腮腺肿瘤 术后放疗 靶区勾画 疾病进展 预后 |
| 英文关键词:parotid gland neoplasms postoperative radiotherapy target delineation disease progression prognosis |
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| 中文摘要: |
| 摘 要：［目的］ 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率，探讨腮腺癌术后放疗合适的区域放疗靶区。［方法］ 回顾性收集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癌患者。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法进行生存分析，并采用Cox比例风险回归模型评估生存结果。［结果］ 共纳入180例腮腺癌患者，根据不同的放疗区域分为照射颈部淋巴结引流区组（152例）与未照射组（28例）、照射乳突组（63例）与未照射组（117例）、照射海绵窦组（12例）与未照射组（168例）（组别之间相互独立）。共有37例患者出现不同部位的疾病进展；照射颈部淋巴结引流区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年无进展生存率分别为81.2%、76.7%，总生存率分别为88.7%、86.8%。照射颈部淋巴结引流区组与未照射组患者5年无进展生存率分别为76.1%和80.5%（P=0.791），照射乳突组与未照射组患者5年无进展生存率分别为65.6% 和81.5%（P=0.057），照射海绵窦组与未照射组患者5年无进展生存率分别为55.6%和78.7%（P=0.097）。T3~4期为p/cN0患者的不良预后因素；N0患者照射颈部淋巴结引流区组与未照射组5年无进展生存率分别为85.4%和82.9%（P=0.567）。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复发，T4期未照射海绵窦组患者5年无进展生存率明显优于照射组（68.1% vs 25.0%，P<0.05）。多因素分析显示，女性、pT3~4分期与患者总生存相关；女性、年龄≥48岁、pT3~4分期、pN1~3与无进展生存相关。［结论］ T4期或腺样囊性癌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期等N0患者建议对颈部淋巴结引流区域放疗。 |
| 英文摘要: |
| Abstract：［Objective］To observe the control and survival of preventive radiation in different regions after parotid gland cancer surgery，to explore appropriate regional radiotherapy targets for prophylactic irradiation following parotid gland cancer surgery. ［Methods］ A retrospective analysis was conducted on parotid gland cancer patients who received postoperative radiotherapy at Jiangsu Cancer Hospital between January 2013 and December 2021. Target volumes were reviewed using the Varian system， and radiological follow-up was performed to assess recurrences within the target areas. Survival analysis was carried out 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. Based on the irradiated regions， patients were divided into the following groups： irradiated cervical nodal region (neck) (n=152) vs non-irradiated (n=28)； irradiated mastoid region (n=63) vs non-irradiated (n=117)； and irradiated cavernous sinus region (n=12) vs non-irradiated (n=168) (the groups were independent of each other). Disease progression occurred in 37 patients at various sites. Within the cervical nodal region， disease progression was observed in 9 cases in the irradiated group and 2 cases in the non-irradiated group (including cases with concurrent distant metastasis). In the mastoid region， one case of progression occurred in the irradiated group， while no progression was observed in the non-irradiated group. No disease progression occurred in the cavernous sinus region in either group. The 3-year and 5-year progression-free survival(PFS) rates for all patients were 81.2% and 76.7%， respectively， and the overall survival (OS) rates were 88.7% and 86.8%， respectively. The 5-year PFS rates were 76.1% vs 80.5% (P=0.791) for the irradiated vs. non-irradiated cervical nodal region groups； 65.6% vs 81.5% (P=0.057) for the irradiated vs non-irradiated mastoid region groups； and 55.6% vs 78.7% (P=0.097) for the irradiated vs non-irradiated cavernous sinus region groups. In p/cN0 patients， T3~4 stage was an adverse prognostic factor. The 5-year PFS rates for N0 patients in the irradiated cervical nodal region group and the non-irradiated group were 85.4% and 82.9%， respectively (P=0.567). Among T4 stage and adenoid cystic carcinoma patients， no recurrence was observed in the mastoid or cavernous sinus regions in either the irradiated or non-irradiated groups. Furthermore， in the T4 subgroup， the non-irradiated cavernous sinus group showed significantly superior 5-year PFS compared to the irradiated group (68.1% vs 25.0%， P<0.05). Multivariate analysis indicated that female and advanced T stage (pT3~4) were associated with OS， while female， age ≥48 years old， advanced T stage (pT3~4)， and advanced N stage (pN1~3) were associated with PFS. ［Conclusion］ For patients with advanced T stage or adenoid cystic carcinoma， careful consideration should be given regarding irradiation of the mastoid and cavernous sinus regions. For T1~2N0 patients， radiotherapy targeted only at the tumor bed is recommended. For N0 patients with factors such as female， older age， and advanced T stage (T3~4)， irradiation of the cervical nodal regions is suggested. |
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