Objective To analyze the efficacy of delineating the clinical target volume(CTV)following the trajectory of trigeminal nerve branches and elective neck irradiation(ENI)in postoperative intensity-modulated radiotherapy(IMRT)for adenoid cystic carcinoma of head and neck(ACCHN).Methods In this study,the data of ACCHN patients without distal metastasis who received postoperative radiotherapy after radical surgery at the Ninth People's Hospital of Shanghai Jiaotong University School of Medicine from January 2016 to December 2022 were retrospectively analyzed.Postoperative radiotherapy target zone and intensity-modulated radiotherapy plan for ACCHN were formulated according to the site of primary focus,whether nerve invasion and pathological staging.Kaplan-Meier method was applied to perform survival analysis,while assessing the tumor local control rate and locoregional recurrence pattern under this target zone outlining principle.Results A total of 309 ACCHN patients were included.With a median follow-up of 49 months,the 5-year local control rate was 93.2％,the 5-year overall survival rate,locoregional recurrence-free survival rate,and distant metastasis-free survival rate were 90.8％,90.6％,66.3％,respectively.Twenty-three patients developed locoregional recurrence,including 14 with primary tumor recurrence alone,5 with regional lymph node recurrence alone,and 4 with both primary and regional lymph node recurrence.Among the patients with primary tumor recurrence,11 had recurrence related to the trigeminal nerve branches,and 7 had recurrence in the tumor bed or surgical bed region,with no out-of-field recurrence.Among the 9 patients with lymph node recurrence,none had undergone neck dissection.Conclusions Delineating the CTV following the trigeminal nerve branches in postoperative radiotherapy for ACCHN achieves excellent local control.Elective neck irradiation avoids irradiation of the entire neck lymphatic drainage area with a low regional recurrence rate.
关键词
头颈部肿瘤/癌,腺样囊性/术后放射疗法/靶区勾画/三叉神经走行
Key words
Head and neck neoplasms/Carcinoma,adenoid cystic/Postoperative radiotherapy/Target volume delineation/Trigeminal nerve branches
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万方数据