2012年10月28-31日，第54届美国放射肿瘤学会（ASTRO）年会在美国波士顿举行。来自世界各地的放射肿瘤学领域的医生及相关人士共计11000多人参会。本届年会的主题是“通过创新改善患者治疗（Advancing Patient Care through Innovation）”。金宝搏网站登录技巧 对本届年会进行了专题报道（http://zt.cmt.com.cn/zt/astro2012/index.html），敬请关注！

　　会上，美国埃默里大学Winship肿瘤研究所的J.J. Beitler报告了RTOG 90-03研究最终结果，其摘要如下：

RTOG 90-03: Final Report

Purpose/Objective(s)
RTOG 90-03 was designed to test whether any of 3 altered radiation fractionation (AF) schemes improved locoregional (LR) tumor control rates for patients with squamous cell cancers of the head and neck when compared to standard fractionation (SFX) of 70 Gy using daily 2-Gy fractions (fxns) delivered 5 days a week.

Materials/Methods
Patients with stage III or IV (or stage II base of tongue cancer) squamous cell cancer were randomized to 4 treatment arms: (1) SFX- 70 Gy/35 daily fxns/7 week; (2) HFX-81.6 Gy/68 BID fxns/7 weeks; (3) AFS-67.2 Gy/42 fxns/6 weeks with a 2 week rest after 38.4 Gy; and (4) AFC-72 Gy/42 fxns/6 weeks (1.8 Gy to initial field and then 1.5 Gy to boost field BID for last 12 fxns of initial field). Neither chemotherapy nor IMRT were employed in initial management. The study was designed to have 80% power to detect an absolute improvement in LR control rate from 40% to 55% with an eligible sample size of 1080. LR control was assessed using Gehan test-weighted log-rank test.

Results
One thousand one hundred thirteen patients were randomized, of whom 1,076 eligible patients were analyzed. Sixty percent of these patients (n = 650) had oropharyngeal (OP) cancers. p16 status was subsequently tested in 190 OP patients (29%) and was positive in 75 (39%). The median follow-up time of surviving patients was 14 years. Five-year LR control rates were SFX-45%, HFX-51% (p = .0462 vs. SFX), AFS-46% (p = 0.2287), and AFC-51% (p = 0.0965). After adjustment for study stratification variables, disease-free survival (DFS) rates were significantly improved for HFX (p = 0.046) and nearly so for AFC (p = 0.052), and AFS (p = 0.056). There were no significant differences in overall survival or the rate of distant metastases by treatment arm. The 15-year overall survival rate was 10%, and one-third of deaths (323/954) were attributed to unrelated/other/unknown causes. Prevalences of late RTOG grade 3-5 toxicities were 8% (SFX), 10% (HFX), 17% (AFS), and 16% (AFC) at 5 years. Any feeding tube use after 180 days from the start of therapy was seen in these groups of NED patients; SFX-35%, HFX-45%, AFS-41%, AFC-42%, oral cavity primary-42%, OP-41%, hypopharynx-44%, and larynx-38%. Feeding tube rates at 1 year were: SFX-26%, HFX-29%, AFS-21%, and AFC-32%. None of these toxicity rates are statistically different. Cumulative incidence of second primary cancers at 15 years was SFX-20%, HFX-21%, AFS-20%, and AFC-20%.

Conclusions
Non-IMRT radiation alone caused significant long term toxicities, including at least transient use of a feeding tube in 35%-45% of the NED study population beyond 180 days from start of therapy, and 21%-32% feeding tube use at 1 year. Long-term toxicities did not significantly vary by treatment arm. Short-term improvements in LR control did not translate into long-term improvements in survival. Second primary cancers and deaths from other causes affected 20% and 34% of our patients, respectively.