Department of Radiation Oncology, National Cancer Centre Singapore, Singapore.
Radiother Oncol. 2012 Sep;104(3):305-11. doi: 10.1016/j.radonc.2011.12.028. Epub 2012 Jan 24.
We sought to evaluate the nature and frequency of late toxicities in a cohort of nasopharyngeal cancer (NPC) patients treated with conventional radiotherapy alone.
Seven-hundred and ninety-six consecutive NPC patients treated using conventional radiotherapy at a single center from 1992 to 1995 were retrospectively analyzed. Patients with histology proven, completely staged, Stage I-IVB World Health Organization Type I-III NPC and completed radical radiotherapy were included. Patients with incomplete staging investigations, distant metastases at diagnosis, previous treatment, and incomplete radiotherapy were excluded. Radiotherapy-related complications were categorized using the RTOG Late Radiation Morbidity Scoring Criteria.
Median follow-up was 7.2 years. The 5-year overall survival and disease free survival were 69% and 56%, respectively, and the corresponding 10-year rates were 52% and 44%. Among 771 patients with at least 3 months of follow-up post treatment, 565 (73%) developed RT-related complications. Diagnosed neurological complications were cranial nerve palsies (n=70; 9%), temporal lobe necrosis (n=37; 5%), Lhermitte's syndrome (n=7; 1%), and brachial plexopathy (n=2; 0.3%). Non-neurological complications included xerostomia (n=353; 46%), neck fibrosis (n=169; 22%), hypo-pituitarism (n=48; 6%), hearing loss (n=120; 16%), dysphagia (n=116; 15%), otorrhea (n=101; 13%), tinnitus (n=94; 12%), permanent tube feeding (n=61; 8%), trismus (n=45; 6%), second malignancies within treatment field (n=17; 2%), and osteo-radionecrosis (n=13; 2%).
While radiotherapy is curative in NPC, many patients suffer significant late treatment morbidities with conventional radiotherapy techniques.
我们旨在评估单纯常规放疗治疗的鼻咽癌（NPC）患者的迟发性毒性的性质和频率。
我们回顾性分析了 1992 年至 1995 年在单一中心接受常规放疗的 796 例连续 NPC 患者。纳入组织学证实、完全分期、I-IVB 期世界卫生组织（WHO）I-III 型 NPC 且接受根治性放疗的患者。排除分期检查不完整、诊断时远处转移、既往治疗和放疗不完全的患者。采用 RTOG 迟发性放射损伤评分标准对放疗相关并发症进行分类。
中位随访时间为 7.2 年。5 年总生存率和无病生存率分别为 69%和 56%，相应的 10 年生存率分别为 52%和 44%。在至少有 3 个月治疗后随访的 771 例患者中，565 例（73%）发生了 RT 相关并发症。诊断为神经并发症有颅神经麻痹（n=70；9%）、颞叶坏死（n=37；5%）、莱尔米特综合征（n=7；1%）和臂丛神经病（n=2；0.3%）。非神经并发症包括口干（n=353；46%）、颈部纤维化（n=169；22%）、垂体功能减退（n=48；6%）、听力损失（n=120；16%）、吞咽困难（n=116；15%）、耳漏（n=101；13%）、耳鸣（n=94；12%）、永久性管饲（n=61；8%）、牙关紧闭（n=45；6%）、治疗野内的第二原发恶性肿瘤（n=17；2%）和骨放射性坏死（n=13；2%）。
虽然放疗对 NPC 是有效的，但许多患者在接受常规放疗技术治疗后会出现严重的迟发性治疗并发症。
