Department of Radiation Oncology, Cancer Hospital of Fujian Medical University, Fuzhou, Fujian, PR China.
BMC Cancer. 2010 Feb 10;10:39. doi: 10.1186/1471-2407-10-39.
To investigate the outcome of locoregionally advanced nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT) after induction chemotherapy, with or without concomitant chemotherapy.
Between August 2003 and March 2007, 370 patients with locoregionally advanced NPC were treated with IMRT. Presenting stages were stage IIB in 62, stage III in 197, and stage IVA/B in 111 patients. All patients except for 36 patients with cervical lymphadenopathy of 4 cm or less in diameter received 2 cycles of cisplatin-based neoadjuvant chemotherapy. Forty-eight patients received cisplatin-based concurrent chemotherapy as well.
With a median follow-up time of 31 months (range 5 to 61 months), the 3-year local control, regional control, metastasis-free survival (MFS), disease-free survival (DFS) and overall survival (OS) rates were 95%, 97%, 86%, 81% and 89%, respectively. Multivariate analyses revealed that both age (< or = 60 vs. >60) and N-classification are significant prognosticators for OS (P = 0.001, hazard ratio [HR] 2.395, 95% confidence interval [CI] 1.432-4.003; P = 0.012, hazard ratio [HR] 2.614, 95% confidence interval [CI] 1.235-5.533); And N-classification is the only significant predicative factor for MFS (P = 0.002, [HR] 1.99, 95% CI 1.279-3.098). T-classification and concurrent chemotherapy were not significant prognostic factors for local/regional control, MFS, DFS, or OS. Subgroup analysis revealed that concurrent chemotherapy provided no significant benefit to IMRT in locoregionally advanced NPC, but was responsible for higher rates of grade 3 or 4 acute toxicities (50% vs. 29.8%, P < 0.005). No grade 3 or 4 late toxicity including xerostomia was observed. However, two patients treated with IMRT and neoadjuvant but without concurrent and adjuvant chemotherapy died of treatment related complications.
IMRT following neoadjuvant chemotherapy produced a superb outcome in terms of local control, regional control, MFS, DFS, and OS rates in patients with stage IIB to IVB NPC. Effective treatment strategy is urgently needed for distant control in patients diagnosed with locoregionally advanced NPC.
本研究旨在探讨诱导化疗后采用调强放疗（IMRT）治疗局部晚期鼻咽癌（NPC）的疗效，比较单纯 IMRT 与 IMRT 联合同期化疗的疗效。
2003 年 8 月至 2007 年 3 月，共 370 例局部晚期 NPC 患者接受了 IMRT 治疗。其中 62 例为 IIB 期，197 例为 III 期，111 例为 IVA/B 期。除 36 例颈淋巴结直径<4cm 的患者外，所有患者均接受了 2 周期顺铂为基础的新辅助化疗。48 例患者接受了顺铂同期化疗。
中位随访时间 31 个月（5-61 个月），3 年局部控制率、区域控制率、无转移生存率（MFS）、无病生存率（DFS）和总生存率（OS）分别为 95%、97%、86%、81%和 89%。多因素分析显示，年龄（≤60 岁 vs. >60 岁）和 N 分期是 OS 的独立预后因素（P=0.001，HR 2.395，95%CI 1.432-4.003；P=0.012，HR 2.614，95%CI 1.235-5.533）；N 分期是 MFS 的唯一独立预后因素（P=0.002，HR 1.99，95%CI 1.279-3.098）。T 分期和同期化疗不是局部/区域控制、MFS、DFS 或 OS 的独立预后因素。亚组分析显示，同期化疗并未使局部晚期 NPC 患者从 IMRT 中获益，但导致更严重的 3 级或 4 级急性毒性（50% vs. 29.8%，P<0.005）。未观察到 3 级或 4 级晚期毒性，包括口干症。然而，2 例接受 IMRT 新辅助治疗而未接受同期和辅助化疗的患者因治疗相关并发症死亡。
诱导化疗后采用 IMRT 治疗 IIB 至 IVB 期 NPC，可显著提高局部控制率、区域控制率、MFS、DFS 和 OS。对于局部晚期 NPC 患者，迫切需要有效的远处控制治疗策略。
