调强放射治疗时代II期鼻咽癌患者的长期生存情况

Long-term survival of nasopharyngeal carcinoma patients with Stage II in intensity-modulated radiation therapy era.

作者信息

Guo Qiaojuan, Lu Tianzhu, Lin Shaojun, Zong Jingfeng, Chen Zhuhong, Cui Xiaofei, Zhang Yu, Pan Jianji

机构信息

Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China.

出版信息

Jpn J Clin Oncol. 2016 Mar;46(3):241-7. doi: 10.1093/jjco/hyv192. Epub 2016 Jan 10.

DOI:10.1093/jjco/hyv192

PMID:26755831

Abstract

OBJECTIVES

To evaluate the long-term survival and the role of chemotherapy in nasopharyngeal carcinoma (NPC) patients in Stage II treated by intensity-modulated radiation therapy (IMRT).

METHODS

Three hundred and eleven NPC patients in Stage II were reviewed. All were treated with IMRT with or without chemotherapy, with 191, 20 and 100 patients being defined as T1N1M0, T2N0M0 and T2N1M0 stage, respectively.

RESULTS

At a median follow-up of 57 months, the 5-year overall survival, disease-specific survival, distant metastasis-free survival, loco-regional relapse-free survival (LRRFS) and progression-free survival were 91.1, 93.5, 90.6, 95.9 and 87.6%, respectively. T2N1 patients had significant poorer survival outcomes than T1N1 patients, with T2N0 patients in between. Further analysis showed that the addition of chemotherapy could only improve LRRFS [hazard ratio (HR) 0.263, 95% confidence interval (CI) 0.083-0.839, P = 0.024], especially for T1N1 patients (HR 0.209, 95% CI 0.046-0.954, P = 0.043). For those in the T2N1M0 group, chemotherapy, as used in our series, added no benefit to any endpoint.

CONCLUSIONS

IMRT in NPC patients in Stage II was quite therapeutic; however, different subgroups have distinct survival outcomes. Distant metastasis was the main failure pattern, especially for those with T2N1 disease, and the chemotherapy currently in use failed to treat subclinical metastatic foci effectively. Further prospective study is warranted to find out the role and the optimal schedule of chemotherapy in this subgroup of patients.

摘要

目的

评估接受调强放射治疗（IMRT）的Ⅱ期鼻咽癌（NPC）患者的长期生存情况及化疗的作用。

方法

回顾了311例Ⅱ期NPC患者。所有患者均接受了有或无化疗的IMRT治疗，其中191例、20例和100例患者分别被定义为T1N1M0、T2N0M0和T2N1M0期。

结果

中位随访57个月时，5年总生存率、疾病特异性生存率、无远处转移生存率、无局部区域复发生存率（LRRFS）和无进展生存率分别为91.1%、93.5%、90.6%、95.9%和87.6%。T2N1患者的生存结果明显比T1N1患者差，T2N0患者介于两者之间。进一步分析表明，添加化疗仅能改善LRRFS[风险比（HR）0.263，95%置信区间（CI）0.083 - 0.839，P = 0.024]，尤其是对于T1N1患者（HR 0.209，95% CI 0.046 - 0.954，P = 0.043）。对于T2N1M0组的患者，在我们的系列研究中，化疗对任何终点指标均无益处。