Lu Jiade J, Shakespeare Thomas, Goh Boon Cher, Tiong Chua Eu, Back Michael, Mukherjee Rahul, Wynne Christopher J, Tan Kim Siang Luke
Department of Radiation Oncology, National University Hospital, Singapore, Singapore.
Am J Clin Oncol. 2004 Apr;27(2):132-5. doi: 10.1097/01.coc.0000046592.90778.fc.
The local control of nasopharyngeal carcinoma after conventional radiotherapy has historically been suboptimal. Recently, investigators have reported improved outcomes for this patient population with the use of combined chemoradiotherapy. The purpose of this analysis of our prospective treatment protocol was to evaluate the additional value of high-dose rate intracavitary brachytherapy (HDRIB) on the disease response, local control, and survival. Between March 1999 and January 2001, 16 patients with newly diagnosed locally advanced (stage III and IV) nasopharyngeal carcinoma were treated prospectively at the Radiation Oncology Department of the National University Hospital of Singapore. All patients were staged according to the AJCC (1997) Staging System and had early T stages (T1 and T2). Treatments included concurrent external beam radiotherapy (EBRT) and chemotherapy as follows: 66 Gy to the primary tumor in conventional fractionation with cisplatin based concurrent chemotherapy followed by adjuvant cisplatin and 5-fluorouracil (5-FU) chemotherapy. Ten Gy of HDRIB in 2 weekly fractions were delivered after the completion of EBRT to all 16 patients. All patients were evaluable for treatment response, local control, survival, and toxicity analysis. The median follow-up for the whole group of patients was 18 months (range: 10-34 months). All patients obtained pathologic complete response at the primary site at 4 months after the completion of the treatment. At the time of this analysis, 15 (93.8%) patients are alive with no evidence of disease. One patient (6.2%) developed locoregional recurrence in the neck at 9 months, and distant metastasis at 11 months after the completion of treatment. Our experience has shown adjuvant HDRIB after concurrent chemoradiation offers encouraging disease response, local control, and survival. A prospective study is being planned to further evaluate the role of adjuvant HDRIB after concurrent chemoradiation on treatment outcome.
在历史上，传统放疗后鼻咽癌的局部控制一直不太理想。最近，研究人员报告称，联合放化疗可改善该患者群体的治疗效果。本前瞻性治疗方案分析的目的是评估高剂量率腔内近距离放疗（HDRIB）对疾病反应、局部控制和生存的附加价值。1999年3月至2001年1月期间，新加坡国立大学医院放射肿瘤科对16例新诊断的局部晚期（III期和IV期）鼻咽癌患者进行了前瞻性治疗。所有患者均根据美国癌症联合委员会（AJCC，1997年）分期系统进行分期，且T分期较早（T1和T2）。治疗包括同步外照射放疗（EBRT）和化疗，具体如下：对原发肿瘤进行常规分割放疗，剂量为66 Gy，同时进行顺铂同步化疗，随后进行辅助顺铂和5-氟尿嘧啶（5-FU）化疗。在EBRT完成后，对所有16例患者每周分2次给予10 Gy的HDRIB。所有患者均可进行治疗反应、局部控制、生存和毒性分析。全组患者的中位随访时间为18个月（范围：10 - 34个月）。所有患者在治疗完成后4个月时原发部位均获得病理完全缓解。在本次分析时，15例（93.8%）患者存活且无疾病证据。1例患者（6.2%）在治疗完成后9个月出现颈部局部区域复发，11个月出现远处转移。我们的经验表明，同步放化疗后辅助HDRIB可带来令人鼓舞的疾病反应、局部控制和生存效果。目前正在计划进行一项前瞻性研究，以进一步评估同步放化疗后辅助HDRIB对治疗结果的作用。
