Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd, 100, Taipei, Taiwan.
Strahlenther Onkol. 2013 Dec;189(12):1001-8. doi: 10.1007/s00066-013-0429-8. Epub 2013 Oct 27.
The purpose of this work was to examine outcomes in patients with T4 nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).
Between 2007 and 2010, 154 patients with nonmetastatic T4 NPC were treated with IMRT to a total dose of 70 Gy in 33-35 fractions. In addition, 97% of patients received concurrent platinum-based chemotherapy. The median follow-up time was 52.8 months.
The rates of 5-year actuarial locoregional control, distant metastasis-free survival, progression free-survival, and overall survival (OS) were 81.2, 72.2, 61.9, and 78.1%, respectively. A total of 27 patients had locoregional recurrence: 85.2% in-field failures, 11.1% marginal failures, and 3.7% out-of-field failures. Fourteen patients with locoregional recurrence received aggressive treatments, including nasopharyngectomy, neck dissection, or re-irradiation, and the 5-year OS rate tended to be better (61.9%) compared to those receiving conservative treatment (32.0%, p=0.051). In patients treated with 1 course of radiotherapy, grade ≥3 toxicities of ototoxicity, neck fibrosis, xerostomia, epistaxis, and radiographic temporal lobe necrosis occurred in 18.2, 9.8, 6.3, 2.1, and 5.6% of patients, respectively. Increased ototoxicity, osteonecrosis, severe nasal bleeding, and temporal necrosis were observed in patients treated by re-irradiation.
IMRT offers good locoregional control in patients with T4 NPC. For patients with locoregional recurrence after definitive radiotherapy, aggressive local treatment may be considered for a better outcome.
本研究旨在探讨调强放疗（IMRT）治疗 T4 期鼻咽癌（NPC）患者的疗效。
2007 年至 2010 年间，154 例非转移性 T4 NPC 患者接受 IMRT 治疗，总剂量为 70 Gy，分 33-35 次给予。此外，97%的患者接受同期含铂化疗。中位随访时间为 52.8 个月。
5 年局部区域无复发生存率、远处无转移生存率、无进展生存率和总生存率（OS）分别为 81.2%、72.2%、61.9%和 78.1%。共有 27 例患者发生局部区域复发：14 例（85.2%）为腔内失败，2 例（11.1%）为边缘失败，1 例（3.7%）为野外失败。14 例局部区域复发患者接受了积极治疗，包括鼻咽切除术、颈清扫术或再放疗，5 年 OS 率（61.9%）明显优于接受保守治疗（32.0%，p=0.051）。在接受 1 个疗程放疗的患者中，分别有 18.2%、9.8%、6.3%、2.1%和 5.6%的患者发生了 3 级及以上的耳毒性、颈部纤维化、口干、鼻出血和放射性颞叶坏死。在接受再放疗的患者中，观察到耳毒性、骨坏死、严重鼻出血和颞叶坏死的发生率增加。
IMRT 为 T4 NPC 患者提供了良好的局部区域控制。对于根治性放疗后局部区域复发的患者，积极的局部治疗可能会获得更好的结果。
