使用体积调制电弧疗法(VMAT)治疗皮肤野癌(SFC)的现场放射治疗-来自100个连续野的结果

G. Fogarty, S. Young, S. Lo, James O’ Toole, M. Wanklyn, David Wong, S. Sinclair, G. Gottschalk, P. Guitera, S. Shumack
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引用次数: 2

摘要

简介:皮肤癌变(SFC)是由长时间暴露在阳光下引起的,并且随着年龄的增长而增加,特别是在皮肤白皙的个体中。皮肤的多个区域可能会受到影响,导致生活质量和美容质量下降。侵袭性皮肤癌可引起发病甚至死亡。传统疗法的长期疗效令人失望。体积调制电弧治疗(VMAT)允许有效的明确放疗治疗大凸皮肤场。这项回顾性的单机构研究报告了74例患者的100个连续SFC领域的病例系列。方法:通过科室病历对同一临床医师(GBF)使用VMAT治疗SFC的前100个野区进行鉴定。收集患者、领域、治疗和结局因素进行分析。收集第一次咨询的日期,以计算一段时间内的转诊率。结果:首例患者于2013年10月完成治疗,最后一例患者于2020年5月完成治疗。74例患者中位年龄76岁,主要为男性(84%)。至少75%的患者之前接受过SFC治疗,11%的患者免疫抑制。20%的患者接受了不止一个领域的VMAT治疗。发现93个角化细胞谱系区,大多数涉及腿部(27),头皮(23)或鼻子(20)。平均规划目标体积(PTV)大小为175(范围5 - 1282)cm3。平均处方剂量为50 (15 - 72)Gy,平均给药剂量为45 (4 - 72)Gy。64个(69%)领域完成了规定的课程。现场复发15例(16%)。12个月时意向治疗的现场控制率为89%。对于完成规定治疗的患者,12个月时的现场控制率为98%,而未完成治疗的患者为71% (p < 0.0001)。PTV大小不影响治疗完成。在完成规定治疗的患者中,复发与PTV大小和剂量无关。转诊率随着时间的推移而增加。结论:VMAT治疗SFC是可行且有效的,只要全程完成。这些发现支持我们的国家方案。有必要进行更多的研究来预测放射敏感性,以便更好地进行治疗。还需要研究在出现症状之前识别有下肢淋巴水肿风险的患者,以确保治疗完成,从而降低复发风险。
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Field-based radiotherapy using volumetric modulated arc therapy (VMAT) for skin field cancerisation (SFC)–outcomes from 100 consecutive fields
Introduction: Skin field cancerisation (SFC) arises from prolonged sun exposure and increases with age, especially in fair skinned individuals. Multiple areas of the skin can be involved, resulting in poor quality of life and cosmesis. Invasive skin cancer can arise causing morbidity and even death. The long-term efficacy of traditional treatments is disappointing. Volumetric modulated arc therapy (VMAT) allows efficient definitive radiotherapy treatment of large convex skin fields. This retrospective, single-institution study presents a case series of 100 consecutive SFC fields in 74 patients. Methods: The first 100 fields treated with VMAT for SFC by the same clinician (GBF) were identified through departmental medical records. Patient, field, treatment, and outcome factors were collected for analysis. The date of the first consultation was collected to calculate the rate of referrals over time. Results: The first patient completed treatment in October 2013 and the last patient in May 2020. Seventy-four mostly male (84%) patients with a median age of 76 years were identified. At least 75% had previously undergone treatment for SFC and 11% were immunosuppressed. Twenty percent of patients had more than one field treated with VMAT. Ninety-three fields of keratinocytic lineage were found with most involving the legs (27), scalp (23) or nose (20). Average planning target volume (PTV) size was 175 (range 5 - 1282) cm3. Average prescribed dose was 50 (range 15 - 72) Gy, average delivered dose was 45 (range 4 - 72) Gy. Sixty-four (69%) of fields completed the prescribed course. There were 15 (16%) in-field recurrences. In-field control on an intention-to-treat basis was 89% at 12 months. For those who completed the prescribed treatment, in-field control at 12 months was 98% as compared with 71% for those who did not (p <.0001). PTV size did not impact treatment completion. In those who completed the prescribed treatment, recurrence was not associated with PTV size nor dose. The rate of referrals increased over time. Conclusion: VMAT for SFC is feasible and effective if the whole course is completed. These findings support our national protocol. More research is warranted to predict radiosensitivity so that treatment can be better tailored. Research to identify patients at risk of lower leg lymphoedema before they become symptomatic is also needed to ensure treatment completion thereby reducing the risk of recurrence.
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