Wu Shao-Xiong, Chua Daniel T T, Deng Mei-Ling, Zhao Chong, Li Feng-Yan, Sham Jonathan S T, Wang Han-Yu, Bao Yong, Gao Yuan-Hong, Zeng Zhi-Fan
Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou, Guangdong, China.
Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):761-9. doi: 10.1016/j.ijrobp.2007.03.037. Epub 2007 Jul 2.
Local recurrence remains one of the major causes of failure in nasopharyngeal carcinoma (NPC). Stereotactic radiosurgery and fractionated stereotactic radiation therapy (FSRT) have recently evolved as a salvage option of NPC. This study was conducted to review the treatment outcome after FSRT for NPC.
Between September 1999 and December 2005, 90 patients with persistent (Group 1: n = 34, relapse within 6 months of RT) or recurrent (Group 2: n = 56, relapse beyond 6 months) NPC received FSRT using multiple noncoplanar arcs of 8-MV photon to the target. Median FSRT dose was 18 Gy in three fractions (Group 1) or 48 Gy in six fractions (Group 2). Median follow-up was 20.3 months.
Complete response rate after FSRT was 66% for Group 1 and 63% for Group 2. One-, 2-, and 3-year disease-specific survival (DSS) and progression-free survival (PFS) rates for all patients were 82.6%, 74.8%, 57.5%, and 72.9%, 60.4%, 54.5%, respectively. Three-year local failure-free survival, DSS, and PFS rates were 89.4%, 80.7%, and 72.3% for Group 1, and 75.1%, 45.9%, and 42.9% for Group 2, respectively. Multivariate analysis showed that recurrent disease and large tumor volume were independent factors that predicted poorer DSS and PFS. Seventeen patients developed late complications, including 2 with fatal hemorrhage.
Our results indicate that FSRT is effective for patients with persistent and recurrent NPC. Compared with reported results of radiosurgery, FSRT provides satisfactory tumor control and survival with a lower risk of complications and it may be a better treatment for local failures of NPC.
局部复发仍然是鼻咽癌（NPC）治疗失败的主要原因之一。立体定向放射外科和分次立体定向放射治疗（FSRT）最近已发展成为鼻咽癌的一种挽救性治疗选择。本研究旨在回顾FSRT治疗鼻咽癌后的疗效。
1999年9月至2005年12月期间，90例持续性（第1组：n = 34，放疗后6个月内复发）或复发性（第2组：n = 56，放疗后6个月后复发）鼻咽癌患者接受了FSRT，使用8兆伏光子的多个非共面弧照射靶区。第1组FSRT中位剂量为18 Gy，分3次照射；第2组为48 Gy，分6次照射。中位随访时间为20.3个月。
第1组FSRT后的完全缓解率为66%，第2组为63%。所有患者的1年、2年和3年疾病特异性生存率（DSS）和无进展生存率（PFS）分别为82.6%、74.8%、57.5%和72.9%、60.4%、54.5%。第1组的3年局部无失败生存率、DSS和PFS分别为89.4%、80.7%和72.3%，第2组分别为75.1%、45.9%和42.9%。多因素分析显示，复发性疾病和肿瘤体积大是预测DSS和PFS较差的独立因素。17例患者出现晚期并发症，其中2例因致命性出血死亡。
我们的结果表明，FSRT对持续性和复发性鼻咽癌患者有效。与报道的放射外科治疗结果相比，FSRT能提供令人满意的肿瘤控制和生存率，且并发症风险较低，可能是鼻咽癌局部复发更好的治疗方法。
