Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Oral Oncol. 2012 Sep;48(9):864-9. doi: 10.1016/j.oraloncology.2012.03.001. Epub 2012 Mar 24.
To evaluate the clinical outcomes of using intensity-modulated radiotherapy (IMRT) in the primary treatment of nasopharyngeal carcinoma (NPC) in Northwest China, including assessments of failure patterns, toxicities and potential prognostic factors.
Between January 2006 and June 2010, 193 newly diagnosed non-metastatic NPCs were treated by IMRT with simultaneous-integrated boost (SIB) technique in Xijing Hospital of Northwest China. Cisplatin-based chemotherapy was offered to 85.5% patients. Acute and late toxicities were graded according to the Radiation Therapy Oncology Group (RTOG) scoring criteria. Prognostic factors were assessed by univariate or multivariate analysis. Statistical analyses were performed on survival and failure patterns.
Median follow-up was 34 months. WHO type II was the predominant histology for NPCs (69.9%) in our study group. Twelve patients experienced local regional failure and total distant metastasis occurred in 34 patients, representing the major mode of failure. The 3-year local recurrence-free (LRFS), regional recurrence-free (RRFS), distant metastasis-free (DMFS) and overall survival (OS) rates were 86.6%, 86.7%, 86.4%, and 85.7%, respectively. Multivariate analyses showed N-classification, age (≤ 50 vs. >50) and WHO type (WHO II vs. WHO III) were independent predictors for DMFS, LRFS and OS. Tumor volume (≤ 50 cm(3) vs. >50 cm(3)) and presence of anemia were independent significant prognostic factors for profession-free survival (PFS). No significant difference was observed between different T categories. Acute and late toxicities were mild or moderate. No grade IV toxicities were observed.
WHO II was the predominant histology and a significant poor prognostic factor in our study group, indicating different carcinogenetic pathways of NPC between endemic and non-endemic regions. Our experience of using IMRT in the treatment of NPC in non-endemic region showed excellent locoregional control and favorable toxicity profiles.
评估在中国西北地区使用调强放疗（IMRT）对鼻咽癌（NPC）进行原发治疗的临床结果，包括对失败模式、毒性和潜在预后因素的评估。
在 2006 年 1 月至 2010 年 6 月期间，193 例新诊断的非转移性 NPC 患者在西北西京医院接受了调强放疗同步整合增敏（SIB）技术治疗。85.5%的患者接受了顺铂为基础的化疗。急性和晚期毒性根据放射治疗肿瘤学组（RTOG）评分标准进行分级。通过单变量或多变量分析评估预后因素。对生存和失败模式进行统计分析。
中位随访时间为 34 个月。在我们的研究组中，世界卫生组织（WHO）Ⅱ型是 NPC 的主要组织学类型（69.9%）。12 例患者出现局部区域失败，34 例患者发生远处转移，这是主要的失败模式。3 年局部无复发生存率（LRFS）、区域无复发生存率（RRFS）、远处无转移生存率（DMFS）和总生存率（OS）分别为 86.6%、86.7%、86.4%和 85.7%。多变量分析显示，N 分类、年龄（≤50 岁与>50 岁）和 WHO 类型（WHOⅡ型与 WHO Ⅲ型）是 DMFS、LRFS 和 OS 的独立预测因素。肿瘤体积（≤50cm3 与>50cm3）和贫血的存在是无进展生存（PFS）的独立显著预后因素。不同 T 分期之间无显著差异。急性和晚期毒性为轻度或中度。未观察到 4 级毒性。
在我们的研究组中，WHO Ⅱ型是主要的组织学类型，也是一个显著的不良预后因素，表明非流行地区 NPC 的致癌途径与流行地区不同。我们在非流行地区使用调强放疗治疗 NPC 的经验显示出优异的局部区域控制和良好的毒性特征。
