ldtЛучевая диагностика и терапияDiagnostic radiology and radiotherapy2079-5343Baltic Medical Education Center10.22328/2079-5343-2022-13-4-115-123ldt-811Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCLINICAL CASEОпухоли головы и шеи: адъювантная лучевая терапия в режиме гипофракционированияHead and neck cancer: hypofractionated adjuvant radiation therapyhttps://orcid.org/0000-0002-8522-6089СокуренкоВ. П.SokurenkoV. P.

Сокуренко Валентина Петровна — доктор медицинских наук, заведующая отделением радиохирургии и радиотерапии № 4, доцент кафедры радиологии и хирургических технологий

197758, Санкт-Петербург, пос. Песочный, Ленинградская ул., д. 70

Valentina P. Sokurenko — Head of Radiosurgery and Radiation Therapy Department № 4, Associate Professor in radiology and surgical technologies

Saint Petersburg, Pesochny settlement, Leningradskaya str., 70, 197758

valentinasokurenko@yandex.ruhttps://orcid.org/0000-0002-4756-1310КарпенкоА. В.KarpenkoA. V.

Карпенко Андрей Викторович — кандидат медицинских наук, заведующий онкологическим отделением хирургических методов лечения № 3

191104, Санкт-Петербург, Литейный пр., д. 37–39

Andrei V. Karpenko — Head of Oncosurgical Treatment Department No. 3

Saint Petersburg

Andrei_karpenko@mail.ruhttps://orcid.org/0000-0002-7742-8764ЛущаеваТ. А.LushchaevaT. A.

Лущаева Татьяна Александровна — врач-радиотерапевт отделения радиохирургии и радиотерапии № 4, аспирант кафедры радиологии и хирургических технологий

197758, Санкт-Петербург, пос. Песочный, Ленинградская ул., д. 70

Tatiana A. Lushchaeva — Radiation Oncologist in Radiosurgery and Radiation Therapy Department № 4

Saint Petersburg, Pesochny settlement, Leningradskaya str., 70, 197758

luschaeva_tatyana@mail.ruПонежаТ. Е.PonezhaT. E.

Понежа Тамара Евгеньевна — медицинский физик отдела лучевых и комбинированных методов лечения

197758, Санкт-Петербург, пос. Песочный, Ленинградская ул., д. 70

Tamara E. Ponezha — Medical Physicist in Radiation and Combined Treament Department

Saint Petersburg, Pesochny settlement, Leningradskaya str., 70, 197758

Российский научный центр радиологии и хирургических технологий имени академика А.М.ГрановаРоссияA.M.Granov Russian Scientific Center of Radiology and Surgical Technologies of the Ministry of Health of the Russian FederationRussian FederationЛенинградский областной онкологический диспансер имени Л.Д.РоманаРоссияLeningrad Regional Clinical Oncologic Dispensary named after L.D.RomanRussian Federation202218012023134115123Copyright © Сокуренко В.П., Карпенко А.В., Лущаева Т.А., Понежа Т.Е., 20232023Сокуренко В.П., Карпенко А.В., Лущаева Т.А., Понежа Т.Е.Sokurenko V.P., Karpenko A.V., Lushchaeva T.A., Ponezha T.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://radiag.bmoc-spb.ru/jour/article/view/811ВВЕДЕНИЕ

ВВЕДЕНИЕ: Вклад адъювантного лучевого воздействия в конечный результат комбинированного лечения злокачественных новообразований головы (ЗНО) и шеи подтвержден многочисленными исследованиями. Оптимальный срок начала адъювантной лучевой терапии (ЛТ) — 6–8 недель после операции. При упущении рекомендованных сроков послеоперационного облучения отмечено повышение риска рецидива и значимое снижение показателей общей выживаемости. Однако, по данным S.Mitra и соавт. (2022), более половины пациентов с плоскоклеточным раком головы и шеи своевременно не получают адъювантное лучевое лечение. Кроме того, на эффективность комбинированной терапии влияет и общая продолжительность лечения (77–100 дней). Для соблюдения временных рамок лечения ЗНО головы и шеи могут быть использованы альтернативные режимы фракционирования.

ЦЕЛЬ

ЦЕЛЬ: Оценить переносимость и безопасность адъювантной ЛТ в режиме гипофракционирования дозы у больных плоскоклеточным местно-распространенным ВПЧ-негативным раком ротоглотки и полости рта в рамках комбинированного лечения.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ: В работу включены больные плоскоклеточным ВПЧ-негативным раком ротоглотки и полости рта III–IV стадии после оперативного лечения с наличием показаний к проведению адъювантной лучевой терапии в сроки от 8 недель с момента хирургического вмешательства в режиме симультанного интегрированного буста. Методика облучения — объемно-модулированная лучевая терапия (VMAT).

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: Пациенты (n=11) завершили адъювантное лучевое лечение в полном объеме. Интервал между оперативным лечением и адъювантной ЛТ варьировал от 9 до 15 недель. Разовая очаговая доза (РОД) на область высокого и крайне высокого риска составила 2,5–2,75 Гр. По достижении СОД 27–32 Гр (11–13 фракция) у 9 пациентов из 11 развился радиоэпителиит II ст.; лучевые реакции достигли своего максимума (радиоэпителиит III ст., лучевой мукозит III ст., лучевой эпидермит II ст.) к завершению курса.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ: Применение гипофракционных режимов дистанционной лучевой терапии (VMAT) в адъювантном режиме у больных плоскоклеточным местно-распространенным ВПЧ-негативным раком ротоглотки и полости рта представляется безопасным методом лучевого лечения с контролируемой местной лучевой токсичностью.

INTRODUCTION

INTRODUCTION: Effect of adiuvant radiation therapy (RT) on oncologic outcomes is well-known and confirmed by different trials. Optimal time to start RT is 6–8 weeks after surgery. Increasing duration of RT delay beyond that interval leads to decrease in overall survival (OS) and makes loco-regional recurrence (LRC) more probable. However, more than 50% patients do not receive adjuvant treatment in time (Mitra S. et al., 2022). Overall treatment time (77–100 days) is another factor that influences effectiveness of adjuvant RT. In order to keep within that time limits non-conventional regimens of RT can be used.

OBJECTIVE

OBJECTIVE: To test safety and feasibility of hypofractionated adjuvant RT in patients with locally advanced squamous cell carcinoma of oral cavity and oropharynx.

MATERIALS AND METHODS

MATERIALS AND METHODS: Patients with stage III–IV squamous cell carcinoma of oral cavity and oropharynx (n=11) who underwent surgery and have to recieve adjuvant RT in 8 weeks and more after surgery are included. Dose was delivered using Volumetric Modulated Arc Therapy (VMAT) and simultaneous integrated boost.

RESULTS

RESULTS: Patients (n=11) completed RT successfully. Surgery-to-RT interval ranges between 9 and 15 weeks. Dose per fraction on high-risk-CTV varies between 2,5 and 2,75 Gy. Acute side-effects (oral mucositis grade II) presented after 27–32 Gy (11–13 fractions) in 9 patient out of 11 and reached maximum (oral mucositis grade III, radiation dermatitis grade II) at the end of the treatment.

CONCLUSIONS

CONCLUSIONS: Hypofractionated adjuvant RT (VMAT) can be safely used in patients with locally advanced squamous cell carcinoma of oral cavity and oropharynx and local acute toxicity can be controlled.

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