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1.
Purpose: To analyze the patterns of local-regional recurrence in patients with head and neck cancer treated with parotid-sparing conformal and segmental intensity-modulated radiotherapy (IMRT).

Methods and Materials: Fifty-eight patients with head and neck cancer were treated with bilateral neck radiation (RT) using conformal or segmental IMRT techniques, while sparing a substantial portion of one parotid gland. The targets for CT-based RT planning included the gross tumor volume (GTV) (primary tumor and lymph node metastases) and the clinical target volume (CTV) (postoperative tumor bed, expansions of the GTVs and lymph node groups at risk of subclinical disease). Lymph node targets at risk of subclinical disease included the bilateral jugulodigastric and lower jugular lymph nodes, bilateral retropharyngeal lymph nodes at risk, and high jugular nodes at the base of skull in the side of the neck at highest risk (containing clinical neck metastases and/or ipsilateral to the primary tumor). The CTVs were expanded by 5 mm to yield planning target volumes (PTVs). Planning goals included coverage of all PTVs (with a minimum of 95% of the prescribed dose) and sparing of a substantial portion of the parotid gland in the side of the neck at less risk. The median RT doses to the gross tumor, the operative bed, and the subclinical disease PTVs were 70.4 Gy, 61.2 Gy, and 50.4 Gy respectively. All recurrences were defined on CT scans obtained at the time of recurrence, transferred to the pretreatment CT dataset used for RT planning, and analyzed using dose–volume histograms. The recurrences were classified as 1) “in-field,” in which 95% or more of the recurrence volume (Vrecur) was within the 95% isodose; 2) “marginal,” in which 20% to 95% of Vrecur was within the 95% isodose; or 3) “outside,” in which less than 20% of Vrecur was within the 95% isodose.

Results: With a median follow-up of 27 months (range 6 to 60 months), 10 regional recurrences, 5 local recurrences (including one noninvasive recurrence) and 1 stomal recurrence were seen in 12 patients, for a 2-year actuarial local-regional control rate of 79% (95% confidence interval 68–90%). Ten patients (80%) relapsed in-field (in areas of previous gross tumor in nine patients), and two patients developed marginal recurrences in the side of the neck at highest risk (one in the high retropharyngeal nodes/base of skull and one in the submandibular nodes). Four regional recurrences extended superior to the jugulodigastric node, in the high jugular and retropharyngeal nodes near the base of skull of the side of the neck at highest risk. Three of these were in-field, in areas that had received the dose intended for subclinical disease. No recurrences were seen in the nodes superior to the jugulodigastric nodes in the side of the neck at less risk, where RT was partially spared.

Conclusions: The majority of local-regional recurrences after conformal and segmental IMRT were “in-field,” in areas judged to be at high risk at the time of RT planning, including the GTV, the operative bed, and the first echelon nodes. These findings motivate studies of dose escalation to the highest risk regions.  相似文献

2.
低温对放射性腮腺损伤防护作用的临床观察   总被引:7,自引:0,他引:7  
头颈部恶性肿瘤病人放射治疗常伴有腮腺损伤。本文采用腮腺区外敷冰袋的办法降低腮腺区温度。放疗后不同时间测腮腺核素显像和唾液量。结果示,低温组(敷冰+放疗)与照射组比,腮腺损伤较轻,腮腺功能恢复的快,说明此法降温可靠。机体局部低温具有辐射防护作用  相似文献
3.
鼻咽癌调强放疗等效均匀剂量优化方法对腮腺的保护作用   总被引:6,自引:2,他引:4  
目的 探索等效均匀剂量(EUD)优化方法在鼻咽癌调强放疗中对腮腺的保护作用。方法 从已接受调强放疗的鼻咽癌患者中,随机抽取12例。这些患者的治疗计划均是采用物理约束条件优化设计的。以这些计划为基础,将腮腺的物理约束条件改为EUD约束,而保持其他危及器官和靶区的约束条件不变,为每位患者设计一个新的计划,并比较新旧治疗计划。结果 在保证靶区和其他危及器官受照剂量不变情况下,EUD优化能够使腮腺的平均剂量和V30显著降低,经T检验,P值都〈0.05。结论 EUD优化能够降低腮腺的受照剂量,这对降低腮腺放疗并发症具有重要意义,也为靶区加量提供了空间。  相似文献
4.
Damage to salivary glands after radiotherapeutic treatment of head and neck tumours can severely impair the quality of life of the patients. In the current study we have investigated the early-to-late pathogenesis of the parotid gland after radiation. Also the ability to ameliorate the damage using pretreatment with adrenergic or muscarinic receptor agonists is studied. Rats were locally irradiated with or without i.p. pretreatment with phenylephrine (alpha-adrenoceptor agonist, 5 mg kg(-1)), isoproterenol (beta-adrenoceptor agonist, 5 mg kg(-1)), pilocarpine (4 mg kg(-1)), methacholine (3.75 mg kg(-1)) (muscarinic receptor agonists) or methacholine plus phenylephrine. Parotid salivary flow rate, amylase secretion, the number of cells and gland histology were monitored sequentially up to 240 days postirradiation. The effects were described in 4 distinct phases. The first phase (0-10 days) was characterised by a rapid decline in flow rate without changes in amylase secretion or acinar cell number. The second phase (10-60 days) consists of a decrease in amylase secretion and is paralleled by acinar cell loss. Flow rate, amylase secretion and acinar cell numbers do not change in the third phase (60-120 days). The fourth phase (120-240 days) is determined by a further deterioration of gland function but an increase in acinar cell number, albeit with poor tissue morphology. All drug pretreatments used could reduce radiation effects in phase I and II. The protective effects were lost during phase IV, with the exception of methacholine plus phenylephrine pretreatment. The latter combination of drugs ameliorated radiation-damage throughout the entire follow-up time. The data show that combined pre-irradiation stimulation of muscarinic acetylcholine receptors with methacholine plus alpha-adrenoceptors with phenylephrine can reduce both early and late damage, possibly involving the PLC/PIP2 second messenger pathways. This opens perspectives for the development of clinical applicable methods for long-term sparing of parotid glands subjected to radiotherapy of head and neck cancer patients.  相似文献
5.
31例复发性腮腺腺样囊性癌临床分析   总被引:3,自引:0,他引:3  
目的探讨腮腺腺样囊性癌诊断及复发癌治疗方法。方法对31例复发性腮腺腺样囊性癌作临床分析。结果局部切除或浅叶切除复发时间比全腮腺切除复发时间短。复发后采用手术+放疗比单纯手术的疗效好。颈淋巴结转移率低,本组为10.3%(3/29)。结论B超、CT及肿瘤穿刺细胞学检查有助术前诊断。全腮腺切除应视为常规,术后复发可采用扩大切除术,但应补充放疗。预防性颈淋巴结清除术不应视为常规。  相似文献
6.
102例腮腺癌的治疗和预后探讨   总被引:3,自引:0,他引:3  
目的 探讨腮腺癌的手术方式和治疗效果。方法 对102例腮腺癌患者的手术方式和术后放疗化疗进行跟踪随访。结果手术+放疗的五年生存率为80.9%,手术+化疗的五年生存为76.9%,无明显差异。结论 首次手术及术式的选择在腮腺癌的治疗中起着重要作用,而病理类型与预后也密切相关,鳞癌、腺癌及未分化癌预后较差,术后配合放疗化疗的综合治疗以提高生存率。  相似文献
7.
腮腺区面神经鞘瘤临床分析   总被引:2,自引:0,他引:2  
冯唤农  黄钢  郭良 《肿瘤学杂志》2006,12(2):128-129
[目的]探讨腮腺区面神经鞘瘤的临床特点和治疗方法。[方法]对7例腮腺区面神经鞘瘤行手术切除。[结果]1例术中误诊为恶性肿瘤而切除面神经致术后永久面瘫(面神经功能Ⅳ级),2例未损伤神经无面瘫,4例肿瘤切除后损伤面神经术后面瘫(面神经功能Ⅱ~Ⅲ级)。[结论]腮腺区面神经鞘瘤临床少见,术前易误诊,治疗以手术为主,肿瘤应完整切除,术中避免过度牵拉神经以免损伤。  相似文献
8.
Previous studies have shown that extracapsular dissection (ECD) is an alternative approach to superficial parotidectomy (SP) for pleomorphic adenoma parotid tumours, associated with low recurrence rates equal to those following SP, but with significantly reduced morbidity. However, if a malignant tumour masquerades as a clinically benign lump, this approach may be inappropriate. This study addressed this question by analysing the outcome of 821 consecutive patients with parotid tumours treated at one centre over 40 years and with a median 12 (range 5-30) years follow-up. Tumours were classified as 'simple' (discrete, mobile, < 4 cm: n=662) and 'complex' (deep, fixed, facial nerve palsy, > or =4 cm: n=159). Among the 'simple' or clinically benign tumours, 503 patients underwent ECD; 159 patients underwent SP. In all, 32 (5%) clinically benign cases were subsequently revealed as malignant histologies (ECD, 12; SP, 20). For each group, 5- and 10-year cancer-specific survival rates were 100 and 98%, respectively. There were no differences in recurrence rates when subanalysed by surgical groups, but ECD was associated with significantly reduced morbidity (P < 0.001). This study demonstrates that ECD is a viable alternative to superficial parotidectomy for the majority of parotid tumours, associated with reduced morbidity without oncological compromise.  相似文献
9.
腮腺原发性鳞状细胞癌   总被引:2,自引:0,他引:2       下载免费PDF全文
 报道腮腺原发性鳞癌14例,男性11例,女性3例,年龄20~66岁(平均,52岁).Ⅰ期3例,Ⅱ期4例,Ⅲ期7例,均经病理证实,并排除转移性鳞癌和腮腺粘液表皮样癌可能.单纯手术或放疗各2例,手术+放疗6例,动脉化疗+放疗+手术3例,1例仅行动脉化疗.3年、5年生存率分别为38.5%,18.2%.初步探讨其临床病理特点.  相似文献
10.
腮腺Warthin瘤146例临床分析   总被引:1,自引:0,他引:1  
林秀安  刘辉  郑雄 《现代肿瘤医学》2011,19(9):1746-1747
目的:分析Warthin瘤的临床特点,探讨Warthin瘤的诊断与手术治疗方法。方法:对我院近20年来收治的146例经手术治疗的Warthin瘤病例的临床资料进行回顾性分析。结果:男性143例,女性3例,发病高峰年龄为60-70岁,占65.75%。肿瘤位于后下极者101例,占69.18%。96.58%的患者有吸烟史,14.38%的患者有消长史。术前细针穿刺细胞学检查82例,诊断准确率为93.90%。手术方式有腮腺区域性切除术、腮腺浅叶切除术和全腮腺切除术。12例失访,其余患者随访1-20年均未见复发。结论:腮腺Warthin瘤主要发生在50岁以上男性患者。在发病情况、临床表现等方面具有自身的特点。术前细针穿刺细胞学检查可明确诊断。治疗应根据肿瘤的位置、大小的不同情况而采取不同的手术方式,肿瘤位于腮腺后下极者采用区域性切除术是理想选择。  相似文献
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