Hung Tsung-Min, Fan Kang-Hsing, Chen Eric Yen-Chao, Lin Chien-Yu, Kang Chung-Jan, Huang Shiang-Fu, Liao Chun-Ta, Ng Shu-Hang, Wang Hung-Ming, Chang Joseph Tung-Chieh
Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung Department of Otorhinolaryngology, Head and Neck Surgery, Department of Diagnostic Radiology Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Medicine (Baltimore). 2017 Feb;96(6):e6036. doi: 10.1097/MD.0000000000006036.
The purpose of this study is to compare the treatment outcome of different radiation doses of elective neck irradiation (ENI) in nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT).In total, 504 patients with nondisseminated NPC who underwent magnetic resonance imaging before radical IMRT between 2000 and 2008 were retrospectively reviewed. The patients were classified into 2 groups based on the ENI dose: low ENI when the ENI dose was 46 Gy (n = 446) and high ENI when the ENI doses were 50 to 60 Gy (n = 58). All the patients in both the groups received a median dose of 72 Gy to the gross tumor and involved nodes. The fraction size was 2 Gy per fraction. Matching was performed between low ENI and high ENI in a 2:1 ratio, and the matching criteria were N-stage, T-stage, treatment modality, pathology classification, sex, and age.The median follow-up for all patients was 63.5 months. In all patients, the 5-year progression-free survival (PFS), local control (LC), regional control (RC), distant metastasis-free survival (DMFS), overall survival (OS), and cancer-specific survival (CSS) for low ENI and high ENI patients were 69.0% and 63.2% (P = 0.331), 89.0% and 83.9% (P = 0.235), 90.1% and 85.2% (P = 0.246), 86.8% and 76.6% (P = 0.056), 77.5% and 80.8% (P = 0.926), and 84.4% and 82.5% (P = 0.237), respectively. In the matched-pair analysis, the 5-year PFS, LC, RC, DMFS, OS, and CSS for matched low ENI and high ENI patients were 74.1% and 63.2% (P = 0.134), 92.0% and 83.9% (P = 0.152), 90.1% and 85.2% (P = 0.356), 86.2% and 76.6% (P = 0.125), 87.0% and 80.8% (P = 0.102), and 88.6% and 82.5% (P = 0.080), respectively. In the multivariable analysis for all patients, the ENI group was not a significant factor for PFS, LC, RC, DMFS, OS, and CSS.A low ENI dose of 46 Gy in 23 fractions is feasible in NPC patients treated with IMRT, and this concept should be validated in the prospective studies.
本研究的目的是比较接受调强放射治疗（IMRT）的鼻咽癌（NPC）患者中，不同放射剂量的选择性颈部照射（ENI）的治疗效果。回顾性分析了2000年至2008年间，504例在接受根治性IMRT前接受磁共振成像检查的非播散性NPC患者。根据ENI剂量将患者分为两组：ENI剂量为46 Gy时为低ENI组（n = 446），ENI剂量为50至60 Gy时为高ENI组（n = 58）。两组所有患者的大体肿瘤和受累淋巴结均接受中位剂量72 Gy的照射。每次分割剂量为2 Gy。低ENI组和高ENI组按2:1的比例进行匹配，匹配标准为N分期、T分期、治疗方式、病理分类、性别和年龄。所有患者的中位随访时间为63.5个月。在所有患者中，低ENI组和高ENI组患者的5年无进展生存率（PFS）、局部控制率（LC）、区域控制率（RC）、无远处转移生存率（DMFS）、总生存率（OS）和癌症特异性生存率（CSS）分别为69.0%和63.2%（P = 0.331）、89.0%和83.9%（P = 0.235）、90.1%和85.2%（P = 0.246）、86.8%和76.6%（P = 0.056）、77.5%和80.8%（P = 0.926）、84.4%和82.5%（P = 0.237）。在配对分析中，匹配的低ENI组和高ENI组患者的5年PFS、LC、RC、DMFS、OS和CSS分别为74.1%和63.2%（P = 0.134）、92.0%和83.9%（P = 0.152）、90.1%和85.2%（P = 0.356）、86.2%和76.6%（P = 0.125）、87.0%和80.8%（P = 0.102）、88.6%和82.5%（P = 0.080）。在所有患者的多变量分析中，ENI组不是PFS、LC、RC、DMFS、OS和CSS的显著因素。对于接受IMRT治疗的NPC患者，23次分割、46 Gy的低ENI剂量是可行的，这一概念应在前瞻性研究中得到验证。
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