O'Sullivan Brian
Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada.
Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S118-21. doi: 10.1016/j.ijrobp.2007.04.085.
Nasopharyngeal carcinoma (NPC) is especially responsive to both chemotherapy and radiotherapy. It also exhibits a strong and disappointing tendency to metastasize to both regional lymph nodes and distant sites. Distant relapse in NPC is generally fatal and usually relates to advanced-stage presentation, and especially extensive regional lymph node involvement, but also to the presence of the less-differentiated histologic patterns of disease that predominate in the endemic-disease areas of the world. Recent improvements in survival are likely attributable to the adoption of concurrent chemotherapy as a predominant approach, although distant metastases remain as a significant cause of death. Survival improvements probably do not always relate to the use of chemotherapy. Thus contemporary series enjoy a greater advantage compared with historical results because of advances in tumor imaging and radiotherapy delivery. It is impossible to assess the impact of these parameters on previous trial results, and it remains plausible that outcomes may still be significantly influenced by imprecise radiotherapy targeting. The randomized trials in the English literature designed to address the impact of chemotherapy on the survival of NPC patients are discussed. Potential causes of inconsistencies among trials are outlined, and the results of the only individual patient data meta-analysis are summarized. The discussion concludes with some commentary concerning newer strategies for the management of NPC to address the problem of distant metastases.
鼻咽癌（NPC）对化疗和放疗均特别敏感。它还表现出向区域淋巴结和远处转移的强烈且令人失望的倾向。鼻咽癌的远处复发通常是致命的，通常与晚期表现有关，尤其是广泛的区域淋巴结受累，也与世界地方病流行地区占主导的低分化组织学疾病模式的存在有关。近期生存率的提高可能归因于采用同步化疗作为主要方法，尽管远处转移仍然是一个重要的死亡原因。生存率的提高可能并不总是与化疗的使用有关。因此，由于肿瘤成像和放疗技术的进步，当代系列研究与历史结果相比具有更大优势。无法评估这些参数对以往试验结果的影响，而且放疗靶向不精确仍可能对结果产生重大影响，这一点仍然合理。本文讨论了英文文献中旨在探讨化疗对鼻咽癌患者生存率影响的随机试验。概述了试验之间不一致的潜在原因，并总结了唯一的个体患者数据荟萃分析的结果。讨论最后对鼻咽癌治疗的新策略进行了一些评论，以解决远处转移问题。
