Gaspar C, Zapater E, Chust M, Climent M A, Ferrándis E, Muñoz M A, Mengual J L, Berrocal A, Vendrell B J, Arribas L, Guillem V
Servicio de Oncología Médica, Instituto Valenciano de Oncología, C/Prof. Beltrán Báguena, 9 y 19, 46009 Valencia.
Acta Otorrinolaringol Esp. 2000 Nov-Dec;51(8):691-6.
This was a retrospective study of 98 patients (pts.) with histologically confirmed nasopharyngeal carcinoma. The clinico-demographic characteristics were: median age of 53 years (11-83); 74 males and 24 females (ratio 3:1); histology subtype OMS 2-3 in 89 pts. (90.8%); cranial nerve deficits in 11 pts. (11.2%); 50 (51%) were stage T3T4; 68 pts. (69.4%) N2N3 and 77 pts. (78.6%) stage IV. The therapeutic modalities were: radical radiotherapy (RT) alone in 42 pts., chemotherapy (CT) alone in 4 pts., RT + adjuvant CT in 10 pts. and neoadjuvant CT + RT in 42 pts. RT was delivered in wide fields, doses between 50-75 Gy with conventional fractionation. CT consisted in cisplatinum-based schedules (PF in 34 pts., BEC in 9 and others in 13 pts.). Analyzed by treatment, more males and stages N2N3 and IV were accrued in neoCT + RT arm (p < or = 0.05). For the entire population, the overall complete response was achieved in 65 pts. (66.3%); in 27/35 pts. (77.1%) of the RT group and 30/51 pts. (58.8%) of CT + RT group (p 0.07) of pts. with III-IV stages. With a median follow-up of 74.5 months, 32 pts. (32.65%) are alive and free of disease. The projected OS for all pts. was 40 months (m), 51.4% at 3 years (y) and 45.5% at 5 y with a disease free survival of 37 m (0-236). No differences between treatment arms were found (p 0.4). In univariant analysis for OS in stage III-IV pts., age > 50 y, histology OMS1, cranial nerve deficits, stage T3T4 and N2N3, were considered adverse prognostic factors (p < or = 0.05). In multivariant analysis, only age > 50 y and stages T3-T4, N2-N3 were significant (p < or = 0.05). In conclusion, we demonstrated good long term survival without any differences among treatment modalities in pts. with advanced nasopharyngeal carcinomas. New therapeutic approaches are warranted in order to improve the outcome of this patients.
这是一项对98例经组织学确诊的鼻咽癌患者的回顾性研究。临床人口统计学特征如下：中位年龄53岁（11 - 83岁）；男性74例，女性24例（比例为3:1）；89例（90.8%）组织学亚型为OMS 2 - 3；11例（11.2%）有颅神经缺损；50例（51%）为T3T4期；68例（69.4%）为N2N3期，77例（78.6%）为IV期。治疗方式包括：42例单纯根治性放疗（RT），4例单纯化疗（CT），10例放疗 + 辅助化疗，42例新辅助化疗 + 放疗。放疗在大野进行，采用常规分割，剂量为50 - 75 Gy。化疗采用以顺铂为基础的方案（34例采用PF方案，9例采用BEC方案，13例采用其他方案）。按治疗方式分析，新辅助化疗 + 放疗组纳入的男性、N2N3期和IV期患者更多（p≤0.05）。对于全部患者，65例（66.3%）实现了总体完全缓解；放疗组35例中的27例（77.1%）以及放疗 + 化疗组51例中的30例（58.8%）（III - IV期患者的p = 0.07）。中位随访74.5个月时，32例（32.65%）患者存活且无疾病。所有患者的预计总生存期为40个月，3年生存率为51.4%，5年生存率为45.5%，无病生存期为37个月（0 - 236个月）。各治疗组之间未发现差异（p = 0.4）。在III - IV期患者总生存期的单因素分析中，年龄>50岁、组织学类型OMS1、颅神经缺损、T3T4期和N2N3期被视为不良预后因素（p≤0.05）。在多因素分析中，只有年龄>50岁以及T3 - T4期、N2 - N3期具有显著性（p≤0.05）。总之，我们证明了晚期鼻咽癌患者长期生存率良好，各治疗方式之间无差异。有必要采用新的治疗方法以改善这些患者的治疗结果。
