Department of Radiation Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China.
J Cancer Res Clin Oncol. 2013 Jan;139(1):139-45. doi: 10.1007/s00432-012-1313-0. Epub 2012 Sep 18.
To evaluate long-term outcome in nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy.
Between January 2006 and August 2008, 300 patients with histologically proven NPC were enrolled in this multicenter prospective study. All patients received definitive IMRT. Cisplatin-based concurrent chemotherapy was given to patients with stages III-IVb disease.
Median follow-up time was 47.1 months (range 11-68 months). Median survival time was not reached. For all patients, the 4-year local control (LC), regional control (RC), distant metastasis-free survival (DMFS), and overall survival (OS) were 94.0, 95.1, 85.0, and 86.1 %, respectively. Thirty-five patients experienced locoregional failures: 18 were local only, 15 were regional only, and 2 were both local and regional. Forty-two patients developed distant metastasis. Of these, 32 patients had single organ metastasis, and 10 patients had multiple organ metastasis. The most common acute toxicities were mucositis, dermatitis, and xerostomia. Grade 0-2 mucositis, dermatitis, and xerostomia occurred in 200 patients (66.7 %), 288 patients (96.0 %), and 286 patients (95.3 %), respectively. Grade 3 mucositis, dermatitis, and xerostomia were seen in 100 patients (33.3 %), 12 patients (4.0 %), and 14 patients (4.7 %), respectively. No Grade 4 acute toxicities were observed. The most common late toxicity for 284 patients who survived for more than 2 years was xerostomia. At 3 months after treatment, 16.2 % of patients had Grade 1, 73.6 % had Grade 2, and 10.2 % had Grade 3 xerostomia. However, the severity of xerostomia decreased over time. At 24 months, only 12.3 % of patients had Grade 2 xerostomia, and none had Grade 3 or 4 xerostomia.
IMRT for NPC patients achieved excellent long-term locoregional control (LRC) and OS, with acceptable acute and late toxicities. After the treatment, xerostomia was improved over time. Distant metastasis remained the main cause of failure. More effective systemic therapy is demanding for reducing the risk of distant metastasis.
评估调强放疗治疗鼻咽癌（NPC）的长期疗效。
2006 年 1 月至 2008 年 8 月，300 例经组织学证实的 NPC 患者参与了这项多中心前瞻性研究。所有患者均接受根治性调强放疗。III-IVb 期患者接受顺铂为基础的同期化疗。
中位随访时间为 47.1 个月（11-68 个月）。中位总生存时间尚未达到。所有患者的 4 年局部控制（LC）、区域控制（RC）、无远处转移生存（DMFS）和总生存（OS）分别为 94.0%、95.1%、85.0%和 86.1%。35 例患者发生局部区域失败：18 例为局部失败，15 例为区域失败，2 例为局部和区域均失败。42 例发生远处转移。其中 32 例为单一器官转移，10 例为多器官转移。最常见的急性毒性为黏膜炎、皮炎和口干。200 例（66.7%）、288 例（96.0%）和 286 例（95.3%）患者出现 0-2 级黏膜炎、皮炎和口干，100 例（33.3%）、12 例（4.0%）和 14 例（4.7%）患者出现 3 级黏膜炎、皮炎和口干。未观察到 4 级急性毒性。284 例生存时间超过 2 年的患者最常见的晚期毒性为口干。治疗后 3 个月，16.2%的患者出现 1 级口干，73.6%的患者出现 2 级口干，10.2%的患者出现 3 级口干。然而，口干的严重程度随时间逐渐减轻。24 个月时，仅有 12.3%的患者出现 2 级口干，且无 3 级或 4 级口干。
调强放疗治疗 NPC 患者可获得优异的长期局部区域控制（LRC）和总生存（OS），且急性和晚期毒性可接受。治疗后，口干随时间逐渐改善。远处转移仍然是失败的主要原因。需要更有效的全身治疗来降低远处转移的风险。
