在口腔癌中重新考虑围神经侵袭的辐射疗法:更多的覆盖是否改善了结果?
Sarbani Ghosh Laskar1, Anuj Kumar1, Ashwini Adhau1
1Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
Cancer medicine
|August 12, 2025
概括
带有围神经侵入的口腔状细胞癌 (PNI-OSCC) 的辅助放射治疗可能不需要扩大体积. 基于PNI程度和高风险特征的个性化规划是获得更好的结果的关键.
科学领域:
- 在瘤学瘤学.
- 辐射疗法 辐射疗法
- 口腔癌研究 在口腔癌研究.
背景情况:
- 在口腔状细胞癌 (OSCC) 中,周围神经侵入 (PNI) 与侵袭性疾病和降低生存率相关.
- 辅助放射治疗 (RT) 是PNI阳性OSCC的标准,但最佳目标体积的定义尚不清楚.
研究的目的:
- 评估RT目标体积对PNI阳性OSCC的复发和生存的影响.
- 确定影响PNI阳性OSCC患者结果的预后因素.
主要方法:
- 对103名PNI阳性的OSCC患者进行了回顾性分析,这些患者接受了手术和辅助RT治疗 (有或没有化疗).
- 评估了复发模式 (现场,边缘,现场外) 和生存结果 (OS,DFS).
- 用单变量和多变量模型分析预测因素.
主要成果:
- 两年总生存率 (OS) 和无病生存率 (DFS) 分别为63%和57%.
- 现场复发很常见 (70%的局部故障),尽管保守的RT体积,但没有头骨底部复发.
- 广泛的PNI,大神经参与,晚期瘤阶段 (T3 / T4),外节延伸 (ENE) 和入侵深度>10mm与较差的结果有关.
结论:
- 扩大RT体积以涵盖整个头骨神经通路可能不会改善结果,并可能增加毒性.
- 个性化RT规划,考虑到PNI程度,神经参与和其他风险因素,对于优化PNI阳性OSCC治疗至关重要.
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