Perri Francesco, Della Vittoria Scarpati Giuseppina, Buonerba Carlo, Di Lorenzo Giuseppe, Longo Francesco, Muto Paolo, Schiavone Concetta, Sandomenico Fabio, Caponigro Francesco
Francesco Perri, Francesco Caponigro, Head and Neck Medical Oncology Unit, National Tumor Institute of Naples, 80131 Naples, Italy.
World J Clin Oncol. 2013 May 10;4(2):47-51. doi: 10.5306/wjco.v4.i2.47.
To provide efficacy and safety data about the combined use of radiotherapy and chemo-radiotherapy in nasopharyngeal carcinoma (NPC).
We reviewed data of 40 patients with locally advanced NPC treated with induction chemotherapy followed by concomitant chemo-radiotherapy (CCRT) (22/40 patients) or CCRT alone (18/40) from March 2006 to March 2012. Patients underwent fiberoscopy with biopsy of the primitive tumor, and computed tomography scan of head, neck, chest and abdomen with and without contrast. Cisplatin was used both as induction and as concomitant chemotherapy, while 3D conformal radiation therapy was delivered to the nasopharynx and relevant anatomic regions (total dose, 70 Gy). The treatment was performed using 6 MV photons of the linear accelerator administered in 2 Gy daily fraction for five days weekly. This retrospective analysis was approved by the review boards of the participating institutions. Patients gave their consent to treatment and to anonymous analysis of clinical data.
Thirty-three patients were males and 7 were females. Median follow-up time was 58 mo (range, 1-92 mo). In the sub-group of twenty patients with a follow-up time longer than 36 mo, the 3-year survival and disease free survival rates were 85% and 75%, respectively. Overall response rate both in patients treated with induction chemotherapy followed by CCRT and in those treated with CCRT alone was 100%. Grade 3 neutropenia was the most frequent acute side-effect and it occurred in 20 patients. Grade 2 mucositis was seen in 29 patients, while grade 2 xerostomia was seen in 30 patients. Overall toxicity was manageable and it did not cause any significant treatment delay. In the whole sample population, long term toxicity included grade 2 xerostomia in 22 patients, grade 1 dysgeusia in 17 patients and grade 1 subcutaneous fibrosis in 30 patients.
Both CCRT and induction chemotherapy followed by CCRT showed excellent activity in locally advanced NPC. The role of adjuvant chemotherapy remains to be defined.
提供关于鼻咽癌（NPC）放疗与放化疗联合应用的疗效和安全性数据。
我们回顾了2006年3月至2012年3月期间40例局部晚期鼻咽癌患者的数据，这些患者接受了诱导化疗，随后接受同步放化疗（CCRT）（22/40例患者）或单纯CCRT（18/40例）。患者接受了纤维镜检查并对原发肿瘤进行活检，以及头部、颈部、胸部和腹部的增强及非增强计算机断层扫描。顺铂用于诱导化疗和同步化疗，同时对鼻咽部及相关解剖区域进行三维适形放疗（总剂量70 Gy）。治疗采用直线加速器的6 MV光子，每周5天，每天2 Gy分次给药。这项回顾性分析得到了参与机构审查委员会的批准。患者同意接受治疗并同意对临床数据进行匿名分析。
33例为男性，7例为女性。中位随访时间为58个月（范围1 - 92个月）。在随访时间超过36个月的20例患者亚组中，3年生存率和无病生存率分别为85%和75%。接受诱导化疗后再进行CCRT的患者和单纯接受CCRT的患者的总缓解率均为100%。3级中性粒细胞减少是最常见的急性副作用，20例患者出现该症状。29例患者出现2级黏膜炎，30例患者出现2级口干症。总体毒性可控，未导致任何显著的治疗延迟。在整个样本群体中，长期毒性包括22例患者出现2级口干症，17例患者出现1级味觉障碍，30例患者出现1级皮下纤维化。
CCRT以及诱导化疗后再进行CCRT在局部晚期鼻咽癌中均显示出良好的活性。辅助化疗的作用仍有待确定。
