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调强放射治疗可控制鼻咽癌远处转移并提高患者生存率。

Intensity-modulated radiotherapy controls nasopharyngeal carcinoma distant metastasis and improves survival of patients.

作者信息

Chen Xiaoqian, Lei Hao, Liang Zhongguo, Li Ling, Qu Song, Zhu Xiaodong

机构信息

Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, No. 71 Hedi Road, Nanning, 530021 China.

出版信息

Springerplus. 2016 Aug 31;5(1):1459. doi: 10.1186/s40064-016-3117-1. eCollection 2016.

Abstract

BACKGROUND

This study evaluated the distant metastatic outcomes in nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT) plus chemotherapy.

METHODS

530 Non-metastatic NPC patients were retrospectively collected and reviewed after receiving IMRT with or without chemotherapy between June 2006 and December 2011. Patients were treated with one fraction of IMRT daily for 5 days a week for 69.96-74.09 Gy, while 473 (89.2 %) of patients also received chemotherapy.

RESULTS

Patients were followed up for a median follow-up duration of 49 months (range from 5 to 98 months). After treatment, 91 (17.3 %) patients developed distant metastasis. Distant metastasis after treatment was significantly associated with advanced 2010 Union for International Cancer Control (UICC)/American Joint Committee on Cancer (AJCC) T staging (p = 0.034), N stage (p < 0.001), 2010 UICC/AJCC stage (p < 0.001), and tumor recurrence (p = 0.029). However, chemotherapy failed to reduce cancer distant metastasis in early stage patients, the distant metastasis rate was 17.5 % in stage III and 24.2 % in stage IVA-B diseases, after IMRT and chemotherapy. The multivariate analysis showed that cancer remission duration, treatment modality, and metastatic site (p < 0.001, p = 0.027 and p = 0.022, respectively) were all independent predictors for overall survival of NPC patients after IMRT and chemotherapy.

CONCLUSIONS

This study provided insight into the effects of IMRT plus chemotherapy in the treatment of NPC. Future studies will explore the efficacy of more aggressive systemic therapies for high-risk patients with distant metastasis.

摘要

背景

本研究评估了接受调强放疗(IMRT)联合化疗的鼻咽癌(NPC)患者的远处转移结局。

方法

回顾性收集并分析了2006年6月至2011年12月期间接受IMRT联合或不联合化疗的530例非转移性NPC患者。患者每周接受5天IMRT治疗,每天1次,剂量为69.96 - 74.09Gy,其中473例(89.2%)患者还接受了化疗。

结果

患者的中位随访时间为49个月(范围为5至98个月)。治疗后,91例(17.3%)患者发生远处转移。治疗后的远处转移与2010年国际癌症控制联盟(UICC)/美国癌症联合委员会(AJCC)的晚期T分期(p = 0.034)、N分期(p < 0.001)、2010年UICC/AJCC分期(p < 0.001)以及肿瘤复发(p = 0.029)显著相关。然而,化疗未能降低早期患者的癌症远处转移率,IMRT联合化疗后,III期疾病的远处转移率为17.5%,IVA - B期疾病为24.2%。多因素分析表明,癌症缓解持续时间、治疗方式和转移部位(分别为p < 0.001、p = 0.027和p = 0.022)均为NPC患者接受IMRT联合化疗后总生存的独立预测因素。

结论

本研究深入了解了IMRT联合化疗治疗NPC的效果。未来的研究将探索更积极的全身治疗对远处转移高危患者的疗效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3834/5007237/6bd5c6aaf3be/40064_2016_3117_Fig1_HTML.jpg

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