Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
Jpn J Clin Oncol. 2012 Dec;42(12):1152-60. doi: 10.1093/jjco/hys169. Epub 2012 Oct 16.
This study evaluated the outcome of intensity-modulated radiation therapy with simultaneous integrated boost and concurrent chemotherapy for nasopharyngeal cancer.
We analyzed 53 consecutive nasopharyngeal cancer patients who received definitive treatment using intensity-modulated radiation therapy with simultaneous integrated boost and cisplatin-based concurrent chemotherapy. Forty-six patients were treated with concurrent chemoradiation and seven patients with induction chemotherapy plus concurrent chemoradiation. The gross tumor (PTV(70)) received 69.96 Gy (2.12 Gy/fraction), high-risk subclinical disease (PTV(60)) received 59.4 Gy (1.8 Gy/fraction) and low-risk subclinical disease (PTV(56)) received 56.1 Gy (1.7 Gy/fraction) in 33 fractions. Twenty-eight patients were treated with step-and-shoot intensity-modulated radiation therapy and 25 patients with helical tomotherapy. Dosimetric parameters were compared between the two modalities.
The median treatment duration was 49 days (range: 41-65 days). The complete response rate was 92.5%. Three local, two regional, one locoregional and seven distant failures were observed. With the median follow-up of 41 months (range: 8-89 months), the 3- and 5-year local control, locoregional control, disease-free survival and overall survival rates were 91.8 and 91.8%; 87.6 and 87.6%; 77.5 and 70.5%; and 86.4 and 82.1%, respectively. Grade 3 mucositis, dermatitis, leucopenia and grade 4 leucopenia were observed in 10, 1, 2 and 1 patient, respectively. No grade 3 or higher xerostomia occurred. Helical tomotherapy significantly improved dosimetric parameters including the maximum dose, volume receiving >107% of the prescribed dose and uniformity index (D(5)/D(95)).
Intensity-modulated radiation therapy with simultaneous integrated boost with concurrent chemotherapy is a safe and effective treatment modality for nasopharyngeal cancer. Helical tomotherapy has a dosimetric advantage over step-and-shoot intensity-modulated radiation therapy in a clinical setting.
本研究评估了调强放疗同步推量加同期化疗治疗鼻咽癌的疗效。
我们分析了 53 例接受调强放疗同步推量加顺铂同期化疗的鼻咽癌患者。46 例患者接受同期放化疗，7 例患者接受诱导化疗加同期放化疗。大体肿瘤靶区（PTV(70)）接受 69.96 Gy（2.12 Gy/次），高危亚临床疾病靶区（PTV(60)）接受 59.4 Gy（1.8 Gy/次），低危亚临床疾病靶区（PTV(56)）接受 56.1 Gy（1.7 Gy/次），共 33 次。28 例患者采用步进式调强放疗，25 例患者采用螺旋断层放疗。比较两种模式的剂量学参数。
中位治疗时间为 49 天（范围：41-65 天）。完全缓解率为 92.5%。观察到 3 例局部、2 例区域、1 例局部区域和 7 例远处失败。中位随访时间为 41 个月（范围：8-89 个月），3 年和 5 年的局部控制率、局部区域控制率、无疾病生存率和总生存率分别为 91.8%和 91.8%、87.6%和 87.6%、77.5%和 70.5%、86.4%和 82.1%。10 例患者出现 3 级黏膜炎、1 例患者出现 1 级皮炎、2 例患者出现 2 级白细胞减少症和 1 例患者出现 1 级 4 级白细胞减少症。无 3 级或以上口干症发生。与步进式调强放疗相比，螺旋断层放疗在临床实践中显著改善了剂量学参数，包括最大剂量、接受处方剂量>107%的体积和均匀性指数（D(5)/D(95)）。
调强放疗同步推量加同期化疗是治疗鼻咽癌的一种安全有效的治疗方法。螺旋断层放疗在临床实践中具有优于步进式调强放疗的剂量学优势。
