内镜引导下组织间调强近距离放疗和腔内近距离放疗作为早期T期原发性鼻咽癌的辅助放疗
Endoscope-guided interstitial intensity-modulated brachytherapy and intracavitary brachytherapy as boost radiation for primary early T stage nasopharyngeal carcinoma.
作者信息
Wan Xiang-Bo, Jiang Rou, Xie Fang-Yun, Qi Zhen-Yu, Li Ai-Ju, Ye Wei-Jun, Hua Yi-Jun, Zhu Yu-Liang, Zou Xiong, Guo Ling, Mai Hai-Qiang, Guo Xiang, Hong Ming-Huang, Chen Ming-Yuan
机构信息
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China; Department of Radiation Oncology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China; Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center; Guangzhou, P. R. China.
Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China; Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center; Guangzhou, P. R. China.
出版信息
PLoS One. 2014 Mar 3;9(3):e90048. doi: 10.1371/journal.pone.0090048. eCollection 2014.
BACKGROUND
Intracavitary brachytherapy (ICBT) is usually applied as boost radiotherapy for superficial residual of nasopharyngeal carcinoma (NPC) after primary extern-beam radiptherapy (ERT). Here, we evaluated the outcome of endoscope-guided interstitial intensity-modulated brachytherapy (IMBT) boost radiation for deep-seated residual NPC.
METHODOLOGY/PRINCIPAL FINDINGS: Two hundred and thirteen patients with residual NPC who were salvaged with brachytherapy boost radiation during 2005-2009 were analyzed retrospectively. Among these patients, 171 patients had superficial residual NPC (≤1 cm below the nasopharyngeal epithelium) were treated with ICBT boost radiation, and interstitial IMBT boost radiation was delivered to 42 patients with deep-seated residual NPC (>1 cm below the nasopharyngeal epithelium). We found that IMBT boost subgroup had a higher ratio of T2b (81.0% VS 34.5%, P<0.001) and stage II (90.5% VS 61.4%, P = 0.001) than that of ICBT boost subgroup. The dosage of external-beam radiotherapy in the nasopharyngeal (63.0±3.8 VS 62.6±4.3 Gray (Gy), P = 0.67) and regional lymph nodes (55.8±5.0 VS 57.5±5.7 Gy, P = 0.11) was comparable in both groups. For brachytherapy, IMBT subgroup had a lower boost radiation dosage than ICBT subgroup (11.0±2.9 VS 14.8±3.2 Gy, P<0.01). Though the IMBT group had deeper residual tumors and received lower boost radiation dosages, both subgroups had the similar 5-year actuarial overall survival rate (IMBT VS ICBT group: 96.8% VS 93.6%, P = 0.87), progression-free survival rate (92.4% VS 86.5%, P = 0.41) and distant metastasis-free survival rate (94.9% VS 92.7%, P = 0.64). Moreover, IMBT boost radiation subgroup had a similar local (97.4% VS 94.4%, P = 0.57) and regional (95.0% VS 97.2%, P = 0.34) control to ICBT subgroup. The acute and late toxicities rates were comparable between the both subgroups.
CONCLUSIONS/SIGNIFICANCE: IMBT boost radiation may be a promising therapeutic selection for deep-seated residual NPC.
背景
腔内近距离放射治疗（ICBT）通常作为鼻咽癌（NPC）原发外照射放疗（ERT）后浅表残留灶的辅助放疗。在此，我们评估了内镜引导下组织间调强近距离放射治疗（IMBT）对深部残留NPC的辅助放疗效果。
方法/主要发现：回顾性分析了2005年至2009年间接受近距离放射治疗辅助放疗挽救的213例残留NPC患者。在这些患者中，171例浅表残留NPC（鼻咽上皮以下≤1 cm）接受了ICBT辅助放疗，42例深部残留NPC（鼻咽上皮以下>1 cm）接受了组织间IMBT辅助放疗。我们发现IMBT辅助放疗亚组的T2b比例（81.0%对34.5%，P<0.001）和II期比例（90.5%对61.4%，P = 0.001）高于ICBT辅助放疗亚组。两组鼻咽部外照射放疗剂量（63.0±3.8对62.6±4.3格雷（Gy），P = 0.67）和区域淋巴结剂量（55.8±5.0对57.5±5.7 Gy，P = 0.11）相当。对于近距离放射治疗，IMBT亚组的辅助放疗剂量低于ICBT亚组（11.0±2.9对14.8±3.2 Gy，P<0.01）。尽管IMBT组残留肿瘤更深且接受的辅助放疗剂量更低，但两个亚组的5年精算总生存率（IMBT对ICBT组：96.8%对93.6%，P = 0.87）、无进展生存率（92.4%对86.5%，P = 0.41）和无远处转移生存率（94.9%对92.7%，P = 0.64）相似。此外，IMBT辅助放疗亚组与ICBT亚组的局部（97.4%对94.4%，P = 0.57）和区域（95.0%对97.2%，P = 0.34）控制情况相似。两个亚组的急性和晚期毒性发生率相当。
结论/意义：IMBT辅助放疗可能是深部残留NPC的一种有前景的治疗选择。
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