Tang Ling-Long, Chen Lei, Mao Yan-Ping, Li Wen-Fei, Sun Ying, Liu Li-Zhi, Lin Ai-Hua, Mai Hai-Qiang, Shao Jian-Yong, Li Li, Ma Jun
Department of Radiation oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
Imaging Diagnosis and Interventional Center, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
Radiother Oncol. 2015 Aug;116(2):167-73. doi: 10.1016/j.radonc.2015.07.038. Epub 2015 Aug 24.
This study investigated the contribution of intensity-modulated radiotherapy (IMRT) to improved treatment outcome in patients with nasopharyngeal carcinoma (NPC) and parapharyngeal space (PPS) extension.
A total of 1052 cases with PPS extension were retrospectively reviewed, including 512 (48.7%) patients treated with two-dimensional conventional radiotherapy (2D-CRT) and 540 (51.3%) patients treated with IMRT.
Significant differences in local relapse-free survival (LRFS) and overall survival (OS) (P<0.001, P<0.001, respectively), but not distant metastasis-free survival (DMFS; P=0.383), were observed between the 2D-CRT and IMRT groups in univariate analysis. The radiotherapy technique was found to be an independent prognostic factor for death (HR=0.674, 95% CI: 0.537-0.846, P=0.001) and local recurrence (HR=0.486, 95% CI: 0.324-0.727, P<0.001), but not for DMFS. IMRT improved local control in patients with carotid space (CS) involvement compared to 2D-CRT (P<0.001). LRFS was significantly different between patients with and without CS extension in the 2D-CRT group (P<0.001), but not in the IMRT group (P=0.215).
Compared to 2D-CRT, IMRT improved LRFS in patients with PPS extension, especially patients with CS extension, but did not improve DMFS. CS extension was not statistically prognostic for local control in NPC patients with PPS extension.
本研究调查调强放射治疗（IMRT）对改善鼻咽癌（NPC）伴咽旁间隙（PPS）侵犯患者治疗效果的作用。
回顾性分析1052例伴PPS侵犯的患者，其中512例（48.7%）接受二维常规放疗（2D-CRT），540例（51.3%）接受IMRT。
单因素分析显示，2D-CRT组和IMRT组在局部无复发生存率（LRFS）和总生存率（OS）方面存在显著差异（分别为P<0.001，P<0.001），但远处无转移生存率（DMFS；P=0.383）无显著差异。放疗技术是死亡（HR=0.674，95%CI：0.537-0.846，P=0.001）和局部复发（HR=0.486，95%CI：0.324-0.727，P<0.001）的独立预后因素，但不是DMFS的独立预后因素。与2D-CRT相比，IMRT改善了颈动脉间隙（CS）受累患者的局部控制（P<0.001）。2D-CRT组中CS侵犯患者与未侵犯患者的LRFS有显著差异（P<0.001），但IMRT组无显著差异（P=0.215）。
与2D-CRT相比，IMRT改善了PPS侵犯患者尤其是CS侵犯患者的LRFS，但未改善DMFS。CS侵犯对PPS侵犯的NPC患者的局部控制无统计学预后意义。
