State Key Laboratory of Oncology in Southern China, Guangzhou, China ; Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China.
State Key Laboratory of Oncology in Southern China, Guangzhou, China ; Collaborative Innovation Center of Cancer Medicine, Guangzhou, China ; Imaging Diagnosis and Interventional Center, Cancer Center, Sun Yat-sen University, Guangzhou, China.
PLoS One. 2013 Dec 18;8(12):e84586. doi: 10.1371/journal.pone.0084586. eCollection 2013.
To analyze the clinicopathological characteristics, treatment modalities, and potential prognostic factors of radiation-related second malignant neoplasms (SMNs) in a large group of nasopharyngeal carcinoma (NPC) cases.
Institutional electronic medical records of 39,118 patients with NPC treated by definitive radiotherapy between February 1964 and December 2003 were reviewed. A total of 247 patients with confirmed SMN attributable to radiotherapy were included.
Median latency between radiotherapy for NPC and the diagnosis of SMN was 9.5 years (range, 3.1-36.8 years). Squamous cell carcinoma was the most common histologic type, followed by fibrosarcoma and adenocarcinoma. Median progression-free survival and overall survival (OS) of the 235 patients who underwent treatment were 17.3 months and 28.5 months, respectively. The 5-year OS rates were 42.9%, 23.7%, and 0% for the surgery, radiotherapy, and chemotherapy groups, respectively. The independent prognostic factors associated with survival were sex, histologic type, and treatment modality in both the early stage subgroup and the advanced stage subgroup of SMN.
Sex, histologic type, and treatment modality were the significant prognostic factors for SMN. Complete resection offers the best chance for long-term survival. In select patients with locally advanced and unresectable SMN, reirradiation should be strongly considered as a curative option.
分析大量鼻咽癌（NPC）患者中放射相关性第二恶性肿瘤（SMN）的临床病理特征、治疗方式以及潜在的预后因素。
回顾了 1964 年 2 月至 2003 年 12 月期间接受根治性放疗的 39118 例 NPC 患者的机构电子病历。共纳入了 247 例经证实与放疗相关的 SMN 患者。
放疗后至 SMN 诊断的中位潜伏期为 9.5 年（范围，3.1-36.8 年）。最常见的组织学类型是鳞状细胞癌，其次是纤维肉瘤和腺癌。235 例接受治疗的患者的无进展生存和总生存（OS）中位数分别为 17.3 个月和 28.5 个月。手术、放疗和化疗组的 5 年 OS 率分别为 42.9%、23.7%和 0%。在 SMN 的早期和晚期亚组中，与生存相关的独立预后因素为性别、组织学类型和治疗方式。
性别、组织学类型和治疗方式是 SMN 的重要预后因素。完全切除为长期生存提供了最佳机会。对于局部晚期和不可切除的 SMN 患者，强烈考虑再次放疗作为一种根治性选择。
