节拍辅助化疗可改善放射性后持续可检测血浆 Epstein-Barr 病毒脱氧核糖核酸的鼻咽癌患者的治疗效果。

Metronomic adjuvant chemotherapy improves treatment outcome in nasopharyngeal carcinoma patients with postradiation persistently detectable plasma Epstein-Barr virus deoxyribonucleic acid.

机构信息

Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.

Section of Basic Medicine, Department of Nursing, Hung Kuang University, Taichung, Taiwan.

出版信息

Int J Radiat Oncol Biol Phys. 2014 May 1;89(1):21-9. doi: 10.1016/j.ijrobp.2014.01.052.

DOI:10.1016/j.ijrobp.2014.01.052

PMID:24725686

Abstract

PURPOSE

To investigate the effects of adjuvant chemotherapy in nasopharyngeal carcinoma (NPC) patients with persistently detectable plasma Epstein-Barr virus DNA (pEBV DNA) after curative radiation therapy plus induction/concurrent chemotherapy.

METHODS AND MATERIALS

The study population consisted of 625 NPC patients with available pEBV DNA levels before and after treatment. Eighty-five patients with persistently detectable pEBV DNA after 1 week of completing radiation therapy were eligible for this retrospective study. Of the 85 patients, 33 were administered adjuvant chemotherapy consisting of oral tegafur-uracil (2 capsules twice daily) for 12 months with (n=4) or without (n=29) preceding intravenous chemotherapy of mitomycin-C, epirubicin, and cisplatin. The remaining 52 patients who did not receive adjuvant chemotherapy served as the control group.

RESULTS

Baseline patient characteristics at diagnosis (age, sex, pathologic type, performance status, T classification, N classification, and overall stage), as well as previous treatment modality, were comparable in both arms. After a median follow-up of 70 months for surviving patients, 45.5% (15 of 33 patients) with adjuvant chemotherapy and 71.2% (37 of 52 patients) without adjuvant chemotherapy experienced tumor relapses (P=.0323). There were a significant reduction in distant failure (P=.0034) but not in local or regional recurrence. The 5-year overall survival rate was 71.6% for patients with adjuvant chemotherapy and 28.7% for patients without adjuvant chemotherapy (hazard ratio 0.27; 95% confidence interval 0.17-0.55; P<.0001).

CONCLUSIONS

Our retrospective data showed that adjuvant chemotherapy can reduce distant failure and improve overall survival in NPC patients with persistently detectable pEBV DNA after curative radiation therapy plus induction/concurrent chemotherapy.

摘要

目的

研究在根治性放化疗加诱导/同期化疗后持续可检测到血浆 Epstein-Barr 病毒 DNA（pEBV DNA）的鼻咽癌（NPC）患者中辅助化疗的效果。

方法和材料

该研究人群包括 625 名可获得治疗前后 pEBV DNA 水平的 NPC 患者。85 例在完成放射治疗后 1 周内持续可检测到 pEBV DNA 的患者符合本回顾性研究的条件。在这 85 例患者中，33 例接受了辅助化疗，包括口服替加氟-尿嘧啶（每日 2 次，每次 2 粒）12 个月，其中（n=4）或不（n=29）在前静脉化疗用丝裂霉素 C、表阿霉素和顺铂。其余 52 例未接受辅助化疗的患者作为对照组。

结果

存活患者的中位随访时间为 70 个月，在诊断时（年龄、性别、病理类型、表现状态、T 分类、N 分类和总分期）的基线患者特征以及以前的治疗方式在两组之间均无差异。接受辅助化疗的 33 例患者中有 45.5%（15 例）和未接受辅助化疗的 52 例患者中有 71.2%（37 例）发生肿瘤复发（P=.0323）。远处失败率显著降低（P=.0034），但局部或区域复发率无显著降低。接受辅助化疗的患者 5 年总生存率为 71.6%，未接受辅助化疗的患者为 28.7%（危险比 0.27；95%置信区间 0.17-0.55；P<.0001）。