BACKGROUND AND PURPOSE Bilateral elective nodal irradiation (ENI) remains the standard treatment for head and neck squamous cell carcinoma (HNSCC). Unilateral ENI could reduce treatment toxicity and improve health-related quality-of-life (HRQOL). This prospective proof-of-principle trial (NCT02572661) investigated the feasibility, safety and clinical benefits of SPECT/CT-guided ENI of the node-negative contralateral neck. MATERIALS AND METHODS Patients with lateralized T1-3N0-2bM0 HNSCC of the oropharynx, oral cavity, larynx and hypopharynx underwent SPECT/CT after peritumoral 99mTc-nanocolloid injection. Patients without contralateral lymph drainage received ipsilateral ENI only. If lymph drainage to only one contralateral hot spot was visible, ENI to the contralateral neck would be limited to only the level containing the hot spot. The primary endpoint was the incidence of contralateral regional failure (CRF) at 2 years. Toxicity and HRQOL were compared with a 1:1 matched historical cohort that received standard bilateral ENI (B-ENI) with identical planning and treatment techniques. RESULTS Fifty patients were treated with SPECT/CT-guided ENI. After a median follow-up of 33 months (range 18-45), CRF was observed in one patient (2%; 95% confidence interval: 0-6%). Compared to the matched B-ENI group, patients treated with SPECT/CT-guided ENI had significantly lower incidences of grade ≥2 dysphagia (54% vs. 82%; p < 0.001), tube feeding (10% vs. 50%; p < 0.001) and late grade ≥2 xerostomia (9% vs. 54%; p < 0.001). Significant and clinically relevant HRQOL benefits of SPECT/CT-guided ENI were observed on the EORTC QLQ-C30 summary score, and QLQ-HN35 swallowing and dry mouth subscales. CONCLUSION SPECT/CT-guided ENI is associated with a low risk of contralateral regional failure. Compared to B-ENI, SPECT/CT-guided ENI significantly reduces dysphagia, feeding tube placement, and late xerostomia and improves HRQOL.

中文翻译：

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SPECT/CT 引导的头颈癌选择性淋巴结照射在肿瘤学上是安全且毒性较小的：一种可能改变实践的方法

背景和目的 双侧选择性淋巴结照射 (ENI) 仍然是头颈部鳞状细胞癌 (HNSCC) 的标准治疗方法。单侧 ENI 可以降低治疗毒性并改善与健康相关的生活质量 (HRQOL)。这项前瞻性原理验证试验 (NCT02572661) 调查了 SPECT/CT 引导的淋巴结阴性对侧颈部 ENI 的可行性、安全性和临床益处。材料与方法 口咽部、口腔、喉部和下咽部偏侧 T1-3N0-2bM0 HNSCC 患者在瘤周注射 99mTc-纳米胶体后进行 SPECT/CT 检查。没有对侧淋巴引流的患者仅接受同侧 ENI。如果只有一个对侧热点可见淋巴引流，则对侧颈部的 ENI 将仅限于包含热点的水平。主要终点是 2 年时对侧区域衰竭 (CRF) 的发生率。将毒性和 HRQOL 与接受标准双侧 ENI (B-ENI) 并采用相同计划和治疗技术的 1:1 匹配历史队列进行比较。结果 50 名患者接受了 SPECT/CT 引导的 ENI 治疗。中位随访 33 个月（范围 18-45）后，一名患者出现 CRF（2%；95% 置信区间：0-6%）。与匹配的 B-ENI 组相比，接受 SPECT/CT 引导的 ENI 治疗的患者≥2 级吞咽困难的发生率显着降低（54% 对 82%；p < 0.001）、管饲（10% 对 50%； p < 0.001）和晚期 ≥2 级口干症（9% 对 54%；p < 0.001）。在 EORTC QLQ-C30 总分上观察到 SPECT/CT 引导的 ENI 的显着和临床相关 HRQOL 益处，和 QLQ-HN35 吞咽和口干分量表。结论 SPECT/CT 引导的 ENI 与对侧区域衰竭的低风险相关。与 B-ENI 相比，SPECT/CT 引导的 ENI 显着减少了吞咽困难、饲管放置和晚期口干症，并提高了 HRQOL。