Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou, China.
Clin Oncol (R Coll Radiol). 2012 Oct;24(8):569-76. doi: 10.1016/j.clon.2011.11.010. Epub 2011 Dec 29.
To analyse the outcomes and to evaluate the prognostic factors involved in the re-irradiation of locally recurrent nasopharyngeal carcinoma (NPC) using intensity-modulated radiotherapy (IMRT).
A retrospective analysis of 239 NPC patients with local recurrence who were re-irradiated with IMRT between 2001 and 2008 was conducted. The distribution of disease re-staging was 5.4% for stage I, 18.4% for stage II, 29.7% for stage III and 46.4% for stage IV. Cisplatin-based chemotherapy was administered to 117 patients (49.0%) in addition to the IMRT.
The mean D(95) and the V(95) of the gross tumour volume (GTV) were 66.78 Gy and 98.61%, respectively. The mean dose to the GTV was 70.04 Gy (61.73-77.54 Gy). The 5 year overall survival, local recurrence-free survival, distant metastasis-free survival and disease-free survival were 44.9, 85.8, 80.6 and 45.4%, respectively. In a univariate analysis, patient age, recurrent T (rT), recurrent N (rN), recurrent stage, tumour volume, mean dose and mean fractional dose of the GTV were significant prognostic factors for overall survival. In a multivariate analysis, only patient age, rN stage, recurrent stage, mean fractional dose and tumour volume remained significant for overall survival.
Re-irradiation using IMRT is available to improve local tumour control and to prolong patients' survival. A smaller tumour volume, higher fractional dose, younger patient ages, lower rN(0) stage and early recurrent stage are all independent prognostic factors for overall survival of recurrent NPC. It is of clinical importance to select the appropriate recurrent NPC cases for salvage re-irradiation by IMRT.
分析局部复发鼻咽癌（NPC）再次调强放疗（IMRT）的结果，并评估相关预后因素。
回顾性分析 2001 年至 2008 年间 239 例局部复发 NPC 患者再次接受 IMRT 治疗的资料。疾病重新分期的分布为：Ⅰ期 5.4%，Ⅱ期 18.4%，Ⅲ期 29.7%，Ⅳ期 46.4%。117 例患者（49.0%）在接受 IMRT 的同时还接受了顺铂为基础的化疗。
GTV 的平均 D（95）和 V（95）分别为 66.78Gy 和 98.61%，GTV 的平均剂量为 70.04Gy（61.73-77.54Gy）。5 年总生存率、局部无复发生存率、无远处转移生存率和无疾病生存率分别为 44.9%、85.8%、80.6%和 45.4%。单因素分析显示，患者年龄、复发 T（rT）、复发 N（rN）、复发期、肿瘤体积、GTV 平均剂量和平均分次剂量是总生存率的显著预后因素。多因素分析显示，只有患者年龄、rN 分期、复发期、平均分次剂量和肿瘤体积是总生存率的独立预后因素。
再次使用 IMRT 放疗可提高局部肿瘤控制率，延长患者生存期。较小的肿瘤体积、较高的分次剂量、较年轻的患者年龄、较低的 rN（0）分期和早期复发期均是局部复发 NPC 患者总生存率的独立预后因素。选择适当的局部复发 NPC 病例进行 IMRT 挽救性再放疗具有重要的临床意义。
