Greenwalt Julie C, Indelicato Daniel J, Amdur Robert J, Morris Christopher G, Kirwan Jessica M, Mendenhall William M
*Department of Radiation Oncology, University of Florida College of Medicine, Gainesville †University of Florida Proton Therapy Institute, Jacksonville, FL.
Am J Clin Oncol. 2016 Dec;39(6):581-585. doi: 10.1097/COC.0000000000000097.
To report long-term results of primary radiotherapy for nasopharyngeal cancer (NPC) presenting in the adolescent group.
Ten adolescent patients with World Health Organization (WHO) type III NPC were treated with primary radiotherapy at our institution between 1969 and 2007. Median age was 16.5 years (range, 11 to 21). Median radiotherapy dose to the primary target volume was 67.5 Gy (range, 60 to 74.8). The bilateral neck received 51.1 Gy (range, 50 to 60 Gy). Five patients were treated with once-daily radiotherapy and 5 received twice-daily radiotherapy. Three patients received neoadjuvant cisplatin and 5FU, and 1 patient received adjuvant maintenance cisplatin and 5FU.
Median follow-up time was 9.5 years (range, 1.94 to 34.74). Fifteen-year overall survival, cause-specific survival, and progression-free survival rates were all 70%. Fifteen-year local and regional control rates were 100% and 90%. One patient recurred regionally and distantly simultaneously, and 2 patients developed distant metastases alone. All 3 died of their disease within 3 years. One patient died from multiple radiation-induced secondary meningiomas 34 years after radiotherapy. Five patients developed hypothyroidism, 3 developed sensorineural hearing loss, and 4 developed dental complications. The overall rates of CTCAE grade 3, 4, and 5 toxicity were 40%, 10%, and 10%, respectively. Despite high-radiation doses to the skull base, none of the patients in this study developed grade 3+ cognitive or vision toxicity.
Radiotherapy achieves excellent local control in adolescent patients with unresectable WHO type III NPC. Our data support current protocols to systematically tailor treatment volumes and deescalate radiation doses to reduce treatment toxicity.
报告青少年组鼻咽癌（NPC）原发放疗的长期结果。
1969年至2007年间，10例世界卫生组织（WHO）III型NPC青少年患者在我院接受原发放疗。中位年龄为16.5岁（范围11至21岁）。原发靶区的中位放疗剂量为67.5 Gy（范围60至74.8 Gy）。双侧颈部接受51.1 Gy（范围50至60 Gy）。5例患者接受每日一次放疗，5例接受每日两次放疗。3例患者接受新辅助顺铂和5氟尿嘧啶治疗，1例患者接受辅助维持顺铂和5氟尿嘧啶治疗。
中位随访时间为9.5年（范围1.94至34.74年）。15年总生存率、病因特异性生存率和无进展生存率均为70%。15年局部和区域控制率分别为100%和90%。1例患者区域和远处同时复发，2例患者单独发生远处转移。所有3例均在3年内死于疾病。1例患者在放疗后34年死于多发性放射性继发性脑膜瘤。5例患者出现甲状腺功能减退，3例出现感音神经性听力损失，4例出现牙科并发症。CTCAE 3级、4级和5级毒性的总体发生率分别为40%、10%和10%。尽管对头颅底给予了高剂量放疗，但本研究中没有患者出现3级以上的认知或视觉毒性。
放疗在不可切除的WHO III型NPC青少年患者中实现了出色的局部控制。我们的数据支持当前系统性调整治疗靶区并降低放疗剂量以减少治疗毒性的方案。
