Boscolo-Rizzo Paolo, Tirelli Giancarlo, Mantovani Monica, Baggio Vittorio, Lupato Valentina, Spinato Giacomo, Gava Alessandro, Da Mosto Maria Cristina
Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Regional Hospital, Piazzale Ospedale 1, 31100, Treviso, Italy.
Head and Neck Department, University of Trieste, Trieste, Italy.
Eur Arch Otorhinolaryngol. 2015 Nov;272(11):3491-8. doi: 10.1007/s00405-014-3369-8. Epub 2014 Nov 4.
The aim of this study was to evaluate the long-term outcome in Caucasian population of a non-endemic area treated for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) with multidrug platinum-based induction plus concurrent chemoradiotherapy (IC/CCRT) in everyday clinical practice setting. Between May 1990 and July 2007, 75 patients with newly diagnosed histologically confirmed LA-NPC were given IC/CCRT. All patients were judged suitable to receive conventional fractionated course of radiotherapy to a dose of 70 Gy in 35 fractions (2 Gy per fraction). The intended chemotherapy regimen consisted in one cycle of induction chemotherapy followed by radiotherapy concomitantly with two cycles of chemotherapy. Each cycle of chemotherapy included cis-platinum, 100 mg/m(2), and continuous infusion of 5-fluorouracil, 1,000 mg/m(2)/d for 5 days. The median follow-up in survivors was 122 months. The complete response rate after CCRT was 90.7%. The main limiting toxicity was grade 3 and 4 pharyngeal mucositis (46.7%). Five-year cumulative rate of locoregional control (LRC), distant control (DC), overall survival (OS), and event-free survival (EFS) was 80.1, 82.2, 72.0, and 66.7%, respectively. Ten-year cumulative rate of LRC, DC, OS, and EFS was 73.4, 73.8, 57.1, and 55.2%, respectively. At multivariate analysis advanced N category and low hemoglobin levels at baseline were found to be independent predictors for both worse OS and EFS. In everyday clinical practice, treating LA-NPC with cisplatin-based IC/CCRT was relatively safe and long-term effective.
本研究的目的是在日常临床实践环境中，评估非流行地区白种人群局部区域晚期鼻咽癌（LA-NPC）接受多药铂类诱导加同步放化疗（IC/CCRT）的长期疗效。1990年5月至2007年7月期间，75例新诊断的经组织学证实的LA-NPC患者接受了IC/CCRT治疗。所有患者均被判定适合接受常规分割放疗疗程，剂量为70 Gy，分35次照射（每次2 Gy）。预期的化疗方案包括一个诱导化疗周期，随后是放疗并同步进行两个化疗周期。每个化疗周期包括顺铂100 mg/m²，持续输注5-氟尿嘧啶1000 mg/m²/天，共5天。幸存者的中位随访时间为122个月。CCRT后的完全缓解率为90.7%。主要的限制性毒性是3级和4级咽粘膜炎（46.7%）。局部区域控制（LRC）、远处控制（DC）、总生存（OS）和无事件生存（EFS）的5年累积率分别为80.1%、82.2%、72.0%和66.7%。LRC、DC、OS和EFS的10年累积率分别为73.4%、73.8%、57.1%和55.2%。多因素分析发现，晚期N分期和基线时低血红蛋白水平是OS和EFS较差的独立预测因素。在日常临床实践中，用基于顺铂的IC/CCRT治疗LA-NPC相对安全且长期有效。
