一项比较正电子发射断层扫描（PET）引导下剂量递增放疗与传统放疗在局部晚期鼻咽癌放化疗中应用的随机试点试验。
A Randomized Pilot Trial Comparing Position Emission Tomography (PET)-Guided Dose Escalation Radiotherapy to Conventional Radiotherapy in Chemoradiotherapy Treatment of Locally Advanced Nasopharyngeal Carcinoma.
作者信息
Wang Jianshe, Zheng Junnian, Tang Tianyou, Zhu Feng, Yao Yuanhu, Xu Jing, Wang Andrew Z, Zhang Longzhen
机构信息
Department of Radiation Oncology, Affiliated Hospital of Xuzhou Medical College; Cancer Institute of Xuzhou Medical College, Jiangsu, China.
PET-CT Center Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
出版信息
PLoS One. 2015 Apr 27;10(4):e0124018. doi: 10.1371/journal.pone.0124018. eCollection 2015.
BACKGROUND
This pilot trial is designed to determine whether PET/CT-guided radiotherapy dose escalation can improve local control while minimizing toxicity for the treatment of locally advanced nasopharyngeal carcinoma.
METHODS
67 patients were randomized into the three treatment arms: conventional chemoradiotherapy (group A), CT-guided dose escalation chemoradiotherapy (group B) and PET/CT-guided dose escalation chemoradiotherapy (group C). Radiotherapy was delivered using the simultaneous modulated accelerated radiation therapy (SMART) technique in the dose-escalation treatment arms. Patients received concurrent and adjuvant chemotherapy.
RESULTS
The use of PET/CT significantly changed the treatment volume delineation of the gross tumor volume. 3-year local progression-free (LPF) survival rates of three groups were 83.3%, 90.9% and 100%, respectively. The 3-year regional progression-free survival (RPFS) rates were 95.8%, 95.5% and 100%, respectively. The 3-year disease free survival (DFS) rates were 79.2%, 86.4% and 95.2%, respectively. The 3-year overall survival (OS) rates were 83.3%, 90.9% and 95.2%, respectively. The 3-year disease-free survival (DFS) rates were 79.2%, 86.4% and 95.2%, respectively. No patient had grade 4 late toxicity.
CONCLUSIONS
PET/CT-guided dose escalation radiotherapy is well-tolerated and appears to be superior to conventional chemoradiotherapy for locally advanced NPC.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02089204.
背景
本试点试验旨在确定正电子发射断层显像/计算机断层扫描（PET/CT）引导下的放疗剂量递增是否能在将毒性降至最低的同时改善局部晚期鼻咽癌治疗的局部控制。
方法
67例患者被随机分为三个治疗组：传统放化疗（A组）、CT引导下剂量递增放化疗（B组）和PET/CT引导下剂量递增放化疗（C组）。在剂量递增治疗组中，使用同步调强加速放疗（SMART）技术进行放疗。患者接受同步和辅助化疗。
结果
PET/CT的使用显著改变了大体肿瘤体积的靶区勾画。三组的3年局部无进展（LPF）生存率分别为83.3%、90.9%和100%。3年区域无进展生存率（RPFS）分别为95.8%、95.5%和100%。3年无病生存率（DFS）分别为79.2%、86.4%和95.2%。3年总生存率（OS）分别为83.3%、90.9%和95.2%。3年无病生存率（DFS）分别为79.2%、86.4%和95.2%。没有患者出现4级晚期毒性反应。
结论
PET/CT引导下的剂量递增放疗耐受性良好，对于局部晚期鼻咽癌似乎优于传统放化疗。
试验注册
ClinicalTrials.gov NCT02089204。
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