Xie Guo-Feng, Cao Ka-Jia, Li Yin, Huang Pei-Yu
Key Laboratory of Oncology in Southern China, Guangzhou, Guangdong, P. R. China.
Ai Zheng. 2005 Oct;24(10):1246-8.
BACKGROUND & OBJECTIVE: The recurrence rate in skull base is high for nasopharyngeal carcinoma (NPC) patients with cavernous sinus or/and sphenoid sinus involvement. This study was conducted to explore the impact of dose boost in skull base on the recurrence in skull base and survival of NPC patients with cavernous sinus or/and sphenoid sinus involvement.
A total of 120 stage T4 NPC patients with cavernous sinus or/and sphenoid sinus involvement proved by histopathology and computed tomography (CT) were treated in our hospital from Oct. 1996 to Nov. 1998. The irradiation dose was (71.55+/-3.09) Gy in nasopharynx and (58.95+/-6.16) Gy in neck. Of the 120 patients, 27 received irradiation (6-10 Gy) in skull base after radiotherapy (boost group), 93 did not receive irradiation in skull base (control group). Fifty-three patients, 41 in control group and 12 in boost group, received cisplatin-based chemotherapy for 1-3 cycles. The survival rates and the recurrence of the 2 groups were calculated by Kaplan-Meier method and log-rank test.
The clinical characteristics of patients were similar in the 2 groups. The 1-, 3-, 5-year skull base control rates were significantly higher in boost group than in control group (100% vs. 93.4%, 91.8% vs. 76.4%, and 86.8% vs. 65.1%, respectively, P=0.045). The 1-, 3-, 5-year disease-freely survival rates were slightly higher in boost group than in control group (85.2% vs. 75.3%, 59.3% vs. 45.2%, and 51.9% vs. 31.2%, respectively, P=0.084). The median disease-freely survival time was longer in boost group than in control group (60 months vs. 30 months). The prevalences of irradiation-induced brain damage were 7.4% in boost group and 4.3% in control group with no significant difference (P=0.514).
Dose boost in skull base can reduce the recurrence of stage T4 NPC in skull base and tends to enhance the disease-freely survival rate for NPC patients with cavernous sinus or/and sphenoid sinus involvementû it is recommended to such patients.
海绵窦或/和蝶窦受侵的鼻咽癌患者颅底复发率较高。本研究旨在探讨对颅底进行剂量递增放疗对海绵窦或/和蝶窦受侵鼻咽癌患者颅底复发及生存的影响。
1996年10月至1998年11月，我院共收治120例经组织病理学及计算机断层扫描（CT）证实为T4期且海绵窦或/和蝶窦受侵的鼻咽癌患者。鼻咽部照射剂量为（71.55±3.09）Gy，颈部照射剂量为（58.95±6.16）Gy。120例患者中，27例在放疗后接受了颅底追加照射（剂量递增组），93例未接受颅底照射（对照组）。53例患者，其中对照组41例，剂量递增组12例，接受了1 - 3周期的以顺铂为基础的化疗。两组的生存率及复发情况采用Kaplan - Meier法及对数秩检验进行计算。
两组患者的临床特征相似。剂量递增组的1年、3年、5年颅底控制率显著高于对照组（分别为100%对93.4%、91.8%对76.4%、86.8%对65.1%，P = 0.045）。剂量递增组的1年、3年、5年无病生存率略高于对照组（分别为85.2%对75.3%、59.3%对45.2%、51.9%对31.2%，P = 0.084）。剂量递增组的中位无病生存时间长于对照组（60个月对30个月）。剂量递增组放射性脑损伤发生率为7.4%，对照组为4.3%，差异无统计学意义（P = 0.514）。
对颅底进行剂量递增放疗可降低T4期鼻咽癌患者颅底的复发率，并倾向于提高海绵窦或/和蝶窦受侵鼻咽癌患者的无病生存率，推荐应用于此类患者。
