Abstract：Objective To evaluate the efficacy of low-dose radiotherapy in patients with advanced hypopharyngeal cancer without high-risk factors. Methods Clinical data of 235 patients diagnosed with advanced hypopharyngeal cancer treated in Department of Head and Neck Surgery of Shandong Provincial ENT Hospital from December 2013 to August 2018 were retrospectively analyzed. All patients were divided into two groups: low-dose radiotherapy group (50 Gy, n=158) and high-dose radiotherapy group (>60 Gy, n=77). Clinical baseline characteristics, treatment, follow-up and survival of patients were collected. Survival curve was delineated using the Kaplan-Meier method, and the differences in survival between two groups were calculated using the log-rank test. Clinical baseline characteristics between two groups were compared by χ2 test. Univariate and multivariate analyses of prognostic factors were conducted by logistic regression model. Results The median follow-up time was 45 months (5-94 months). The 3-year overall survival (OS) rate of the whole group was 68.5%, and 70.3% and 64.9% in the low-dose and high-dose groups, respectively (P=0.356). The 3-year progression-free survival (PFS) rate of the whole group was 64.3%, and 65.8% and 61.0% in the low-dose and high-dose groups, respectively (P=0.361). Univariate analysis showed that T stage, N stage, lesion location and degree of pathological differentiation significantly affected clinical prognosis (all P<0.05), whereas there was no significant relationship between age, sex, radiotherapy dose, interval between surgery and radiotherapy and survival. Multivariate analysis showed that T stage, N stage and the degree of pathological differentiation were the independent prognostic factors (all P<0.05) of the 3-year OS and PFS. Sex, radiotherapy dose and interval between surgery and radiotherapy were not correlated with OS and PFS. Conclusion This study showed that for hypopharyngeal cancer patients without positive surgical margins and extracapsular extension, postoperative radiotherapy at a dose of 50 Gy given to tumor bed and selective lymph node drainage area does not compromise local disease control and OS.
Tao Hengmin,Shen Zhong,Wang Ru et al. Analysis of clinical efficacy of postoperative low-dose radiotherapy in patients with advanced hypopharyngeal cancer without high-risk factors[J]. Chinese Journal of Radiation Oncology, 2023, 32(2): 111-117.
[1] Pfister DG, Spencer S, Adelstein D, et al.Head and neck cancers, version 2.2020, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2020,18(7):873-898. DOI: 10.6004/jnccn.2020.0031. [2] Riesenbeck D, Dörr W. Documentation of radiation-induced oral mucositis. Scoring systems[J]. Strahlenther Onkol, 1998,174 Suppl 3:44-46. DOI: 10. 1007/BF03038228. [3] Cooper JS, Pajak TF, Forastiere AA, et al.Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck[J]. N Engl J Med, 2004,350(19):1937-1944. DOI: 10.1056/NEJMoa03 2646. [4] Bernier J, Domenge C, Ozsahin M, et al.Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer[J]. N Engl J Med, 2004,350(19):1945-1952. DOI: 10.1056/NEJMoa03 2641. [5] Harari PM, Harris J, Kies MS, et al.Postoperative chemoradiotherapy and cetuximab for high-risk squamous cell carcinoma of the head and neck: radiation therapy oncology group RTOG-0234[J]. J Clin Oncol, 2014,32(23):2486-2495. DOI: 10.1200/JCO.2013.53.9163. [6] Stromberger C, Jann D, Becker ET, et al.Adjuvant simultaneous integrated boost IMRT for patients with intermediate- and high-risk head and neck cancer: outcome, toxicities and patterns of failure[J]. Oral Oncol, 2014,50(11):1114-1121. DOI: 10.1016/j.oraloncology. 2014.08.006. [7] Ferris RL, Geiger JL, Trivedi S, et al.Phase II trial of post-operative radiotherapy with concurrent cisplatin plus panitumumab in patients with high-risk, resected head and neck cancer[J]. Ann Oncol, 2016,27(12):2257-2262. DOI: 10.1093/annonc/mdw428. [8] Nishimura G, Hatakeyama H, Shiono O, et al.Postoperative bio-chemoradiotherapy using cetuximab and docetaxel in patients with cis-platinum-intolerant core high-risk head and neck cancer: protocol of a phase 2 nonrandomized clinical trial[J]. JMIR Res Protoc, 2018,7(8):e11003. DOI: 10.2196/11003. [9] Maihoefer C, Schüttrumpf L, Macht C, et al.Postoperative (chemo) radiation in patients with squamous cell cancers of the head and neck - clinical results from the cohort of the clinical cooperation group "personalized radiotherapy in head and neck cancer"[J]. Radiat Oncol, 2018,13(1):123. DOI: 10.1186/s13014-018-1067-1. [10] Makino W, Heianna J, Ishikawa K, et al.Patterns of recurrence after low-dose postoperative radiotherapy for head and neck squamous cell carcinoma[J]. J Egypt Natl Canc Inst, 2021,33(1):40. DOI: 10.1186/s43046-021-000 98-w. [11] Fletcher GH.Clinical dose response curves of human malignant epithelial tumours[J]. Br J Radiol, 1973,46(542):151. [12] Peters LJ, Goepfert H, Ang KK, et al.Evaluation of the dose for postoperative radiation therapy of head and neck cancer: first report of a prospective randomized trial[J]. Int J Radiat Oncol Biol Phys, 1993,26(1):3-11. DOI: 10.1016/0360-3016(93)90167-t. [13] Ang KK, Trotti A, Brown BW, et al.Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer[J]. Int J Radiat Oncol Biol Phys, 2001,51(3):571-578. DOI: 10.1016/s0360-3016(01)01690-x. [14] Mohanti BK, Thakar A, Kaur J, et al.Postoperative radiotherapy dose requirement in standard combined-modality practice for head and neck squamous cell carcinoma: analysis of salient surgical and radiotherapy parameters in 2 cohorts[J]. Head Neck, 2017,39(9):1788-1796. DOI: 10.1002/hed.24836. [15] Chin RI, Spencer CR, DeWees T, et al. Reevaluation of postoperative radiation dose in the management of human papillomavirus-positive oropharyngeal cancer[J]. Head Neck, 2016,38(11):1643-1649. DOI: 10.1002/hed.24486. [16] Kirke DN, Qureshi MM, Kamran SC, et al.Role of adjuvant chemoradiotherapy in T4N0 stage IV head and neck cancer: a national cancer database analysis[J]. Head Neck, 2018,40(6):1174-1184. DOI: 10.1002/hed.25087. [17] Rosenthal DI, Mohamed A, Garden AS, et al.Final report of a prospective randomized trial to evaluate the dose-response relationship for postoperative radiation therapy and pathologic risk groups in patients with head and neck cancer[J]. Int J Radiat Oncol Biol Phys, 2017,98(5):1002-1011. DOI: 10. 1016/j.ijrobp.2017. 02.218. [18] Ashour MG, Shouman TH, Hassouna AH, et al.Swallowing sparing intensity modulated radiotherapy versus standard parotid sparing intensity-modulated radiotherapy for treatment of head and neck cancer: a randomized clinical trial[J]. Acta Oncol, 2022,61(2):134-140. DOI: 10.1080/0284186X.2021.2022198. [19] Avkshtol V, Handorf EA, Ridge JA, et al.Examining adjuvant radiation dose in head and neck squamous cell carcinoma[J]. Head Neck, 2019,41(7):2133-2142. DOI: 10.1002/hed.25680. [20] Vergeer MR, Doornaert P, de Bree R, et al. Postoperative elective nodal irradiation for squamous cell carcinoma of the head and neck: outcome and prognostic factors for regional recurrence[J]. Ann Oncol, 2011,22(11):2489-2494. DOI: 10.1093/annonc/mdq768. [21] Langendijk JA, Slotman BJ, van der Waal I, et al. Risk-group definition by recursive partitioning analysis of patients with squamous cell head and neck carcinoma treated with surgery and postoperative radiotherapy[J]. Cancer, 2005,104(7):1408-1417. DOI: 10.1002/cncr. 21340. [22] Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, et al. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy[J]. J Clin Oncol, 2008,26(22):3770-3776. DOI: 10.1200/JCO.2007.14.6647. [23] Capuano G, Gentile PC, Bianciardi F, et al.Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment[J]. Support Care Cancer, 2010,18(4):433-437. DOI: 10.1007/s00520-009- 0681-8.
2023, Vol. 32 
