1] State Key Laboratory Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China [2] Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, 651 Dong Feng Road East, Guangzhou, People's Republic of China.
Br J Cancer. 2014 Jan 7;110(1):49-54. doi: 10.1038/bjc.2013.720. Epub 2013 Nov 19.
The objective of this study is to analyse the factors affecting late toxicity for nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT).
Seven hundred and eighty-nine consecutive NPC patients treated with IMRT at our centre from January 2003 to February 2008 were retrospectively analysed. Radiotherapy-related complications were categorised using the RTOG Late Radiation Morbidity Scoring Criteria and the Common Terminology Criteria for Adverse Events (Version 3.0). Two hundred and thirty-three patients were treated with IMRT alone (group 1) and 556 patients underwent cisplatin-based chemotherapy (group 2).
Median follow-up was 65 months (range, 4-106 months). The 5-year major late toxicity rate was significantly greater in group 2 than group 1 (63.2% vs 42.0%, P<0.001). Multivariate analyses showed that N category, T category and chemotherapy were significant factors. The maximal dose (Dmax) to the temporal lobe was a significant factor affecting temporal lobe injury (TLI), with a hazard ratio of 1.26 (95% confidence interval (CI), 1.18-1.35; P<0.001) per 1-Gy increase. The 5-year TLI rate increased from 0.8% for 284 lobes with Dmax <65.77 Gy to 27.1% for 176 lobes with greater doses (P<0.001). Logistic regression showed that the hazard ratio attributed to the parotid gland mean dose was 1.36 (95% CI, 1.21-1.53; P<0.001) per 1-Gy increase. Chemotherapy was not a significant factor (P=0.211).
With the application of IMRT, the incidence of radiation-related complications has been reduced except for TLI. The significant factors affecting the risk of TLI included T category, chemotherapy and Dmax.
本研究旨在分析影响调强放疗（IMRT）治疗鼻咽癌（NPC）患者迟发性毒性的因素。
回顾性分析 2003 年 1 月至 2008 年 2 月在我院接受 IMRT 治疗的 789 例连续 NPC 患者。采用 RTOG 晚期放射损伤评分标准和常见不良事件术语标准（版本 3.0）对放疗相关并发症进行分类。233 例患者接受单纯 IMRT 治疗（组 1），556 例患者接受顺铂为基础的化疗（组 2）。
中位随访时间为 65 个月（范围，4-106 个月）。组 2的 5 年主要迟发性毒性发生率明显高于组 1（63.2%比 42.0%，P<0.001）。多因素分析显示，N 分期、T 分期和化疗是显著因素。颞叶的最大剂量（Dmax）是影响颞叶损伤（TLI）的显著因素，每增加 1Gy，风险比为 1.26（95%置信区间（CI）为 1.18-1.35；P<0.001）。Dmax<65.77Gy 的 284 个颞叶 5 年 TLI 发生率为 0.8%，而 Dmax>65.77Gy 的 176 个颞叶发生率为 27.1%（P<0.001）。Logistic 回归显示，与腮腺平均剂量相关的风险比为 1.36（95%CI 为 1.21-1.53；P<0.001）。化疗不是显著因素（P=0.211）。
随着调强放疗的应用，除 TLI 外，放射性并发症的发生率有所降低。影响 TLI 风险的显著因素包括 T 分期、化疗和 Dmax。
