Fangzheng Wang, Chuner Jiang, Lei Wang, Weijun Chen, Min Xu, Quanquan Sun, Tongxin Liu, Aizawa Rihito, Sakamoto Masoto, Zhenfu Fu
Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Hangzhou, 310022 China.
Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Hangzhou, 310022 China.
Oncotarget. 2017 Jun 13;8(24):39756-39765. doi: 10.18632/oncotarget.14403.
To evaluate the outcomes of 255 patients with nasopharyngeal carcinoma (NPC) treated with four facio-cervical fields conformal radiotherapy (4F-CRT).
In one patient's 3 different RT treatment modalities, the 4F-CRT techniques resulted in sharper of the dose-volume histograms (DVHs) for primary gross tumor volume (PGTVnx) and planning target volume (PTVnx), similar to the intensity modulated radiation therapy (IMRT). The median follow-up duration was 43 months. Locoregional relapse and distant metastases as the first treatment failure events occurred in 32 (32/255, 12.5%) and 20 (30/255, 11.8%) patients, respectively. The 3-year and 5-year local control, disease-free survival, and overall survival rates were 83.3%, 82%, 83.8%, and 76.1%, 73.2%, 76.3% respectively. Univariate analysis displayed that clinical stage, T-stage, N-stage, and tumor response were related to prognosis. Multivariate analysis indicated that age, T-stage, N-stage, and combined chemotherapy were independent prognosticators. The incidence of grade 1-2 acute mucositis and leukocytopenia were 93.7% and 91.0%, respectively, with no cases of grade 4 toxicity detected.
From November 2007 to December 2011, 255 patients with histologically diagnosed, non-metastatic NPC were enrolled into this study and received 4F-CRT. Magnetic resonance imaging scans of the nasopharynx were performed on every patient. All patients received definitive radiotherapy with 6 MV X-rays using conventional fractions at 2 Gy daily, 5 fractions per week, and 231 patients with stage IIb-IV received concurrent chemotherapy and cisplatin-based adjuvant chemotherapy. The accumulated survival was calculated according to the Kaplan-Meier method; the log-rank test was used to compare survival differences. Multivariate analysis was performed using Cox's proportional hazard model.
Compared with the conventional treatment plans, the 4F-CRT plan delivered more dose to cover the tumor volume and reduces the doses of the normal tissues including the parotid gland, TMJs and so on. The long-term efficacy of 4F-CRT is satisfactory and its toxicities are tolerable.
评估255例鼻咽癌（NPC）患者接受四野面颈联合适形放疗（4F-CRT）的疗效。
在1例患者的3种不同放疗治疗方式中，4F-CRT技术使原发大体肿瘤体积（PGTVnx）和计划靶体积（PTVnx）的剂量体积直方图（DVH）更锐利，类似于调强放射治疗（IMRT）。中位随访时间为43个月。分别有32例（32/255，12.5%）和20例（30/255，11.8%）患者发生局部区域复发和远处转移作为首次治疗失败事件。3年和5年的局部控制率、无病生存率和总生存率分别为83.3%、82%、83.8%和76.1%、73.2%、76.3%。单因素分析显示临床分期、T分期、N分期和肿瘤反应与预后相关。多因素分析表明年龄、T分期、N分期和联合化疗是独立的预后因素。1-2级急性粘膜炎和白细胞减少症的发生率分别为93.7%和91.0%，未检测到4级毒性病例。
2007年11月至2011年12月，255例经组织学诊断为非转移性NPC的患者纳入本研究并接受4F-CRT。对每位患者进行鼻咽部磁共振成像扫描。所有患者均采用6MV X射线进行根治性放疗，采用常规分割，每天2Gy，每周5次，231例IIb-IV期患者接受同步化疗和顺铂辅助化疗。根据Kaplan-Meier法计算累积生存率；采用对数秩检验比较生存差异。采用Cox比例风险模型进行多因素分析。
与传统治疗计划相比，4F-CRT计划给予更多剂量以覆盖肿瘤体积，并降低了包括腮腺、颞下颌关节等正常组织的剂量。4F-CRT的长期疗效令人满意，其毒性是可耐受的。
