Dhanachai Mantana, Kraiphibul Puangtong, Dangprasert Somjai, Puataweepong Putipun, Narkwong Ladawan, Laothamatas Jiraporn, Kulapraditharom Boonchu, Sirachainan Ekaphop, Yongvithisatid Pornpan
Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.
Acta Oncol. 2007;46(6):828-33. doi: 10.1080/02841860601103050.
The aim of this study was to evaluate results of fractionated stereotactic radiotherapy (FSRT) in patients with residual or recurrent nasopharyngeal carcinoma (NPC) in terms of local progression-free (LPFS) and overall survival (OS) rate and complications after treatment. There were 32 residual or recurrent NPC patients treated with FSRT using linac-based radiosurgery system. Time from the previous radiotherapy to FSRT was 1-165 months (median, 15). Two patients were treated for the second and one for the third recurrence. Thirteen patients (40.6%) also received chemotherapy with FSRT. Tumor volume ranged from 6.2-215 cc (median, 44.4). Average FSRT dose was 17-59.4 Gy (median, 34.6) in 4-25 fractions (median,6) in 1-5.5 weeks (median, 3). Median follow-up time was 25.5(3-67) months. LPFS rate at 1 and 3 years after FSRT was 67.8% and 37.9%. OS rate at 1 and 3 years was 89.7% and 71.2%. If all patients who had tumor progression with no further follow-up were assumed dead, the OS rate at 1 and 3 years would be 75.0% and 37.9%. Univariate analysis showed better local tumor control in patients with tumor volume </=100 cc (p=0.04) or in those without chemotherapy (p=0.0005). Only chemotherapy retained significance in multivariate analysis (hazard ratio 5.47, 95%CI 1.86-16.04). Eight patients (25%) had complications after FSRT, all grade 2-3 except 1 grade 4 with complete recovery.
本研究旨在评估分割立体定向放射治疗（FSRT）对残留或复发性鼻咽癌（NPC）患者的局部无进展生存率（LPFS）、总生存率（OS）以及治疗后并发症的影响。32例残留或复发性NPC患者接受了基于直线加速器的放射外科系统的FSRT治疗。从上一次放疗至FSRT的时间为1 - 165个月（中位数为15个月）。2例患者接受了第二次治疗，1例患者接受了第三次复发治疗。13例患者（40.6%）在接受FSRT的同时还接受了化疗。肿瘤体积为6.2 - 215立方厘米（中位数为44.4立方厘米）。FSRT的平均剂量为17 - 59.4 Gy（中位数为34.6 Gy），分4 - 25次给予（中位数为6次），治疗时间为1 - 5.5周（中位数为3周）。中位随访时间为25.5（3 - 67）个月。FSRT后1年和3年的LPFS率分别为67.8%和37.9%。1年和3年的OS率分别为89.7%和71.2%。如果假设所有肿瘤进展且未进一步随访的患者均已死亡，那么1年和3年的OS率将分别为75.0%和37.9%。单因素分析显示，肿瘤体积≤100立方厘米的患者（p = 0.04）或未接受化疗的患者（p = 0.0005）局部肿瘤控制效果更好。多因素分析中只有化疗具有显著意义（风险比5.47，95%可信区间1.86 - 16.04）。8例患者（25%）在FSRT后出现并发症，除1例4级并发症完全恢复外，其余均为2 - 3级。
