Miah A B, Bhide S A, Del Rosario L, Matthews J, Nicol R, Tanay M A, Gupta S, Zaidi S H, Newbold K L, Harrington K J, Nutting C M
Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
Clin Oncol (R Coll Radiol). 2016 Aug;28(8):e61-7. doi: 10.1016/j.clon.2016.01.012. Epub 2016 Feb 11.
To determine the toxicity and tumour control rates after chemo-intensity-modulated radiotherapy (chemo-IMRT) for locally advanced nasopharyngeal cancers (LA-NPC).
Patients with LA-NPC were enrolled in a trial to receive induction chemotherapy followed by parotid-sparing chemo-IMRT. The primary site and involved nodal levels received 65 Gy in 30 fractions and at risk nodal levels received 54 Gy in 30 fractions. Incidence of ≥grade 2 subjective xerostomia was the primary end point. Secondary end points included incidences of acute and late toxicities and survival outcomes.
Forty-two patients with American Joint Committee on Cancer stages II (12%), III (26%) and IV (62%) (World Health Organization subtype: I [5%]; II [40%]; III [55%]) completed treatment between January 2006 and April 2010 with a median follow-up of 32 months. Incidences of ≥grade 2 acute toxicities were: dysphagia 83%; xerostomia 76%; mucositis 97%; pain 76%; fatigue 99% and ototoxicity 12%. At 12 months, ≥grade 2 subjective xerostomia was observed in 31%, ototoxicitiy in 13% and dysphagia in 4%. Two year locoregional control was 86.2% (95% confidence interval: 70.0-94.0) with 2 year progression-free survival at 78.4% (61.4-88.6) and 2 year overall survival at 85.9% (69.3-93.9).
Chemo-IMRT for LA-NPC is feasible with good survival outcomes. At 1 year, 31% experience ≥grade 2 subjective xerostomia.
确定局部晚期鼻咽癌（LA-NPC）接受化疗调强放疗（chemo-IMRT）后的毒性和肿瘤控制率。
LA-NPC患者参加一项试验，先接受诱导化疗，随后进行保留腮腺的chemo-IMRT。原发部位及受累淋巴结区域接受65 Gy分30次照射，高危淋巴结区域接受54 Gy分30次照射。≥2级主观口干的发生率为主要终点。次要终点包括急性和晚期毒性的发生率以及生存结果。
42例美国癌症联合委员会分期为II期（12%）、III期（26%）和IV期（62%）（世界卫生组织亚型：I型[5%]；II型[40%]；III型[55%]）的患者在2006年1月至2010年4月期间完成治疗，中位随访时间为32个月。≥2级急性毒性的发生率分别为：吞咽困难83%；口干76%；黏膜炎97%；疼痛76%；疲劳99%；耳毒性12%。在12个月时，观察到≥2级主观口干的发生率为31%，耳毒性为13%，吞咽困难为4%。两年局部区域控制率为86.2%（95%置信区间：70.0 - 94.0），两年无进展生存率为78.4%（61.4 - 88.6），两年总生存率为85.9%（69.3 - 93.9）。
LA-NPC的chemo-IMRT是可行的，生存结果良好。在1年时，31%的患者经历≥2级主观口干。
