oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2017-16-6-18-24oncotomsk-637Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESКРАТКОСРОЧНЫЕ РЕЗУЛЬТАТЫ ХИМИОЛУЧЕВОЙ ТЕРАПИИ БОЛЬНЫХ РАКОМ СЛИЗИСТОЙ ОБОЛОЧКИ РОТОГЛОТКИ С ИСПОЛЬЗОВАНИЕМ УСКОРЕННОГО ГИПОФРАКЦИОНИРОВАНИЯ ДОЗЫ ОБЛУЧЕНИЯSHORT-TERM OUTCOMES OF CHEMORADIOTHERAPY USING ACCELERATED HYPOFRACTIONATION FOR THE TREATMENT OF CANCER OF THE OROPHARYNGEAL MUCOSAРаджаповаМ. У.RadzhapovaM. U.

кандидат медицинских наук, ведущий научный сотрудник отделения протонной и фотонной терапии

SPIN-код: 4127-7361

MD, PhD, Leading Researcher of the Department of Proton and Photon Therapy

SPIN-code: 4127- 7361.

mradzh@mrrc.obninsk.ruГулидовИ. А.GulidovI. A.

доктор медицинских наук, профессор, руководитель отдела лучевой терапии, руководитель отделения протонной и фотонной терапии

SPIN-код: 2492-5581

MD, DSc, Professor, Head of the Department of Radiation Therapy, Head of the Department of Proton and Photon Therapy

SPIN-code: 2492-5581

iagulidov@mrrc.obninsk.ruСеврюковФ. Е.SevryukovF. E.

кандидат медицинских наук, руководитель отдела лучевого и хирургического лечения заболеваний головы и шеи

SPIN-код: 9689-0400

MD, PhD, Head of the Department of Radiation and Surgical Therapy for Head and Neck Diseases

SPIN-code: 9689-0400

sevrukovf@mail.ruГордонК. Б.GordonK. B.

научный сотрудник отделения протонной и фотонной терапии

SPIN-код: 2045-4565

Researcher of the Department of Proton and Photon Therapy

SPIN-code: 2045-4565

СеменовА. В.SemenovA. V.

научный сотрудник отделения протонной и фотонной терапии

SPIN-код: 3901-1284.

Researcher of the Department of Proton and Photon Therapy

SPIN-code: 3901-1284.

imatrosso@gmail.comМедицинский радиологический научный центр им. А.Ф. Цыба – филиал федерального государственного бюджетного учреждения «Национальный медицинский исследовательский центр радиологии» Министерства здравоохранения Российской Федерации, г. ОбнинскРоссияA.F. Tsyb Medical Radiological Research Center – Branch of the Federal State Budget Institution «National Medical Research Center of Radiology» of the Health Ministry of the Russian Federation, ObninskRussian Federation2017231220171661824Copyright © Раджапова М.У., Гулидов И.А., Севрюков Ф.Е., Гордон К.Б., Семенов А.В., 20172017Раджапова М.У., Гулидов И.А., Севрюков Ф.Е., Гордон К.Б., Семенов А.В.Radzhapova M.U., Gulidov I.A., Sevryukov F.E., Gordon K.B., Semenov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/637

Цель исследования – оценка острой токсичности и эффективности методики ускоренного гипофракционирования химиолучевой терапии больных раком ротоглотки. Материал и методы. Клинические наблюдения представлены 54 пациентами с морфологически подтвержденным диагнозом первичного рака слизистой оболочки органов ротоглотки II–IV стадии. Всем пациентам проводилась неоадъювантная полихимиотерапия по схеме PF с последующей самостоятельной лучевой терапией. Использована методика облучения 2,4 Гр за фракцию пять раз в неделю до 62,4 Гр на зоны высокого риска и до 45,6–48 Гр на зоны низкого риска. Результаты. Ответ на неоадъювантную химиотерапию получен в 75,9 % случаев. Стабилизация процесса достигнута у 24,1 % больных. После ускоренной гипофракционированной лучевой терапии ответ опухоли отмечен у 50 (92,6 %), стабилизация – у 4 (7,4 %) пациентов. Полная регрессия выявлена у 38 (76,0 %), частичная – у 12 (24,0 %) больных с объективным ответом. Общая однолетняя выживаемость составила 83,8 %. Частота мукозитов III степени выявлена в 38 (70,4 %), II степени – в 16 (29,6 %) случаях. Вынужденный перерыв в лечении осуществлен у 33 (61,1 %) пациентов. В среднем длительность перерыва равнялась 14,2 ± 2,4 сут. Различия выживаемости у больных, пролеченных с перерывом и при непрерывном лучевом лечении, статистически незначимы (р=0,418). Общая однолетняя выживаемость составила 88,9 и 70,0 % соответственно. Заключение. Оценка краткосрочных результатов и первый опыт изучения методики ускоренного гипофракционирования 2,4 Гр для лечения рака ротоглотки не позволяет нам сделать однозначных выводов. Необходимо динамическое наблюдение за пациентами на предмет оценки поздней токсичности и долгосрочных результатов эффективности терапии.

 

Objectives

Objectives. The purpose of this study was to assess the tolerance and efficacy of accelerated hypofractionated chemoradiotherapy for oropharyngeal cancer. Material and methods. The study included 54 patients with morphologically confirmed primary stage II–IV oropharyngeal cancer. All the patients received neoadjuvant polychemotherapy with the PF regimen followed by radiation therapy alone. Radiation was delivered in daily 2.4 Gy fractions five days per week to high-risk areas up to a total dose of 62.4 Gy and to low-risk areas up to a total dose of 45.6–48 Gy. Results. A response to neoadjuvant chemotherapy was noted in 75.9 % of cases. Stable disease was seen in 24.1 % of patients. After accelerated hypofractionated radiation therapy, 50 (92.6 %) patients demonstrated tumor response and 4 (7.4 %) demonstrated stable disease. A complete response was achieved in 38 (76.0 %) and partial response was achieved in 12 (24.0 %) patients. The one-year overall survival rate was 83.8 %. Grade III and II oral mucositis was observed in 38 (70.4 %) and 16 (29.6 %) of cases, respectively. Therapy had to be interrupted in 33 (61.1 %) patients. On average, the treatment break lasted 14.2 ± 2.4 days. There was no statistically significant difference in survival rates between the patients treated with or without treatment break (p=0.418). The one-year overall survival rates were 88.9 and 70.0 %, respectively. Conclusion. Evaluation of short-term outcomes and our initial experience with accelerated hypofractionated irradiation at 2.4 Gy per fraction in the treatment of oropharyngeal cancer do not still allow us to draw any firm conclusions on these matters. Further follow-up is needed to make an assessment of long-term treatment outcomes and late toxicities.

 

 

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The authors declare that there are no conflicts of interest present.