[预防性上颈部放疗对N0期鼻咽癌的长期疗效]

Chen Chuang-Zhen, Li De-Rui, Chen Zhi-Jian, Li Dong-Sheng, Guo Long-Jia, Guo Hong

Department of Radiation Oncology, Affiliated Tumor Hospital, Medical School, Shantou University, Shantou, Guangdong, 515031, P. R. China.

Ai Zheng. 2008 Mar;27(3):295-8.

BACKGROUND & OBJECTIVE: Whether prophylactic irradiation should cover the whole neck or just the upper neck for nasopharyngeal carcinoma (NPC) patients, without neck lymph node metastasis (N0), remains controversial. This study was to assess the rationality of prophylactic upper neck irradiation for stage N0 NPC patients.

METHODS

Clinical data of 432 stage N0 NPC patients were analyzed. All patients were treated with radical radiotherapy alone. The extent of prophylactic irradiation was limited to the upper neck of the patients. Median radiation doses were 70 Gy for the primary tumors, and 50 Gy for the upper necks. Kaplan-Meier method was used to analyze survival rates and neck recurrence rates. Log-rank test was used to compare neck recurrence rates in patients with or without nasopharyngeal recurrence. Cox proportional hazards model was used to evaluate the prognostic factors for neck control.

RESULTS

Seventeen out of 432 patients had neck recurrence. The 5-year control rate of the neck was 96.06%. Among the 17 patients with neck recurrence, 6 had concurrent nasopharyngeal relapse. The occurrence rates of neck recurrence alone were 0.93%(4/432) in the upper necks and 1.62% (7/432) in the lower necks (P=0.937). The neck recurrence rates were 9.52% (6/63) and 2.98% (11/369) in patients with and without nasopharyngeal recurrence, respectively (P=0.002). Nasopharyngeal recurrence was the only independent prognostic factor for neck control.

CONCLUSION

The overall neck recurrence rate is low for stage N0 NPC patients after receiving irradiation. Prophylactic upper neck irradiation is reasonable for stage N0 NPC patients.

背景与目的

对于无颈部淋巴结转移（N0）的鼻咽癌（NPC）患者，预防性照射应覆盖整个颈部还是仅上颈部仍存在争议。本研究旨在评估对N0期NPC患者进行预防性上颈部照射的合理性。

方法

分析432例N0期NPC患者的临床资料。所有患者均仅接受根治性放疗。预防性照射范围局限于患者的上颈部。原发肿瘤的中位放射剂量为70 Gy，上颈部为50 Gy。采用Kaplan-Meier法分析生存率和颈部复发率。采用对数秩检验比较有无鼻咽癌复发患者的颈部复发率。采用Cox比例风险模型评估颈部控制的预后因素。

结果

432例患者中有17例发生颈部复发。颈部5年控制率为96.06%。在17例颈部复发患者中，6例同时发生鼻咽癌复发。单纯上颈部复发率为0.93%（4/432），下颈部为1.62%（7/432）（P = 0.937）。有和无鼻咽癌复发患者的颈部复发率分别为9.52%（6/63）和2.98%（11/369）（P = 0.002）。鼻咽癌复发是颈部控制的唯一独立预后因素。