Wu Li-Rong, Liu Ya-Tian, Jiang Ning, Fan Yan-Xin, Wen Jing, Huang Sheng-Fu, Guo Wen-Jie, Bian Xiu-Hua, Wang Fei-Jiang, Li Feng, Song Dan, Wu Jian-Feng, Jiang Xue-Song, Liu Ju-Ying, He Xia
Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing 210009, China.
Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing 210009, China.
Oral Oncol. 2017 Jun;69:26-32. doi: 10.1016/j.oraloncology.2017.03.015. Epub 2017 Apr 7.
Intensity-modulated radiotherapy (IMRT) has been applied in nasopharyngeal carcinoma (NPC) for nearly twenty years, while little is known about the ten-year survival outcomes. This study aimed at evaluating the 10-year survival outcomes for patients with NPC receiving IMRT.
Data on 614 patients with newly diagnosed, non-disseminated NPC treated by IMRT between 2004 and 2008 were retrospectively reviewed. Survival outcomes stratified by tumor stage were compared.
The median follow-up duration was 112.7months (range, 7.6-156.8months) for the entire cohort. The 10-year local relapse-free survival rates for T1, T2 and T3 were 94.2%, 92.5% and 91.4% (P>0.05), respectively, and significantly higher than that of T4 disease (79.3%, P<0.05 for all rates). As N category increased from N0 to N3, the 10-year distant metastasis-free survival rates significantly decreased accordingly (P<0.01 for all rates). Furthermore, the 10-year overall survival rates were 100%, 87.1%, 75.5% and 55.6% for stage I, II, III and IV, respectively (P<0.05 except stage I and II). Multivariate analysis established tumor stage and age as independent prognostic factors. Late toxicities were assessable for 495 (80.6%) patients and most were Grade I/II damages. Xerostomia (387 of 489, 79.1%) and hearing impairment (212 of 495, 42.8%) remained the most troublesome.
IMRT could achieve satisfactory survival outcomes for NPC patients with acceptable late toxicities. However, distant control still remains poor, especially for patients with N3 disease.
调强放射治疗（IMRT）应用于鼻咽癌（NPC）已近二十年，但关于十年生存结局的了解却很少。本研究旨在评估接受IMRT的NPC患者的十年生存结局。
回顾性分析2004年至2008年间接受IMRT治疗的614例新诊断、未播散的NPC患者的数据。比较按肿瘤分期分层的生存结局。
整个队列的中位随访时间为112.7个月（范围7.6 - 156.8个月）。T1、T2和T3期的十年局部无复发生存率分别为94.2%、92.5%和91.4%（P>0.05），均显著高于T4期疾病（79.3%，所有率P<0.05）。随着N分期从N0增加到N3，十年远处无转移生存率相应显著降低（所有率P<0.01）。此外，I、II、III和IV期的十年总生存率分别为100%、87.1%、75.5%和55.6%（I期和II期除外，P<0.05）。多因素分析确定肿瘤分期和年龄为独立预后因素。495例（80.6%）患者可评估晚期毒性，大多数为I/II级损伤。口干（489例中的387例，79.1%）和听力障碍（495例中的212例，42.8%）仍然是最麻烦的问题。
IMRT可为NPC患者带来令人满意的生存结局，且晚期毒性可接受。然而，远处控制仍然较差，尤其是对于N3期疾病患者。
